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Michael Hall Application PackageHall Michael JNAME: Last Name First Name Middle Initial 1700 Meridian Avenue, Apt 505 Miami BeachHOME ADDRESS: Apt No.Home No./Street City Florida 33139 State Zip Code (305) 450-0881PHONE: Home Work mjhallmd@me.com; clinic@hallongevity.com Email Address Miami Beach Street 1680 Meridian Avenue City Florida State 33139 Zip Code Address: Hall Longevity Clinic Position:Business Name:Physician Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for a minimum of six months; or b) an individual shall demonstrate ownership/interest for a minimum of six months in a business established in the city. YesƔ5HVLGHQWRI0LDPL%HDFKIRUDPLQLPXPRIVL[PRQWKV Ɣ'HPRQVWUDWHDQRZQHUVKLSLQWHUHVWLQDEXVLQHVVLQ0LDPL%HDFKIRUDPLQLPXPRIVL[PRQWKV Ɣ$UH\RXDUHJLVWHUHGYRWHULQ0LDPL%HDFK Ɣ3OHDVHcircle one): I am now a resident of: Ɣ,DPDSSO\LQJIRUDQDSSRLQWPHQWEHFDXVH,KDYHVSHFLDODELOLWLHVNQRZOHGJHDQGH[SHULHQFH3OHDVHOLVWEHORZ Ɣ$UH\RXSUHVHQWO\DUHJLVWHUHGOREE\LVWZLWKWKH&LW\RI0LDPL%HDFK" Yes Yes South Beach No M.D. General Practice - Medical knowledge, medical business owner and expertise in medical policy. Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3) choices will be observed by the City Clerk’s Office. (Regular Boards of City) Choice 1: Choice 2: Choice 3: Health Facilities Authority Board Health Advisory Committee No2. Present participation in Youth Center activities by your children Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board: No Years of Service: ages, and which programs. List below: if yes, please list the names of your children, their Child Name Age Program CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM * Board members are required to file Form 1 – "Statement of Financial Interest" with the State. If you seek appointment to a professional seat (e.g., lawyer, architect, etc.) on the Board of Adjustment, Design Review Board, Historic Preservation Board or Planning Board, attach a copy of your currently-effectively license, and furnish the following information: Type of Professional License_______________________________ License Number ______________________________ License Issuance Date ___________________________________ License Expiration Date _______________________ NoƔHave you ever been convicted of a felony:If yes, please explain in detail: ƔDo you currently have a violation(s) of City of Miami Beach codes:No If yes, please explain in detail: ƔDo you currently owe the City of Miami Beach any money:No If yes, please explain in detail: ƔAre you currently serving on any City Boards or Committees:No If yes, which board? ƔWhat organizations in the City of Miami Beach do you currently hold membership in? ƔList all properties owned or have an interest in, which are located within the City of Miami Beach: ƔI am now employed by the city of Miami Beach:No Which department? The following information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It is being asked to comply with federal equal opportunity reporting requirements. MaleGender: Physically Challenged:No White Race/Ethnic Categories What is your race? Mark one or more races to indicate what you consider yourself to be. Other Description: Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino.No NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members. These laws include, but are not limited to, the following: o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). o Prohibition from contracting with the city (Miami-Dade County Code section 2-11.1). o Prohibition from lobbying before board/committee you have served on for period of one year after leaving office (Miami Beach Code section 2-26). o Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1). (re: CMB Community Development Advisory Committee): prohibition, during tenure and for one year after leaving office, from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself, or those with whom you have business or immediate family ties (CFR 570.611). Upon request, copies of these laws may be obtained from the City Clerk. “I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Article VII – of the City Code “Standards of Conduct for City Officers, Employees and Agency Members.” I Michael Hall agreed to the following terms on Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date Michael James Hall, MD 1680 Meridian Avenue, Suite 601 Florida 33139 Phone: 305.672.4733 Fax: 305.672.4771 E-Mail: michael@hallongevity.com Professional Experience General Practitioner 03/08-Present Hall Longevity Clinic, Miami Beach, Florida Flight Surgeon Senior Airman Medical Examiner 03/13-Present FAA, Oklahoma City, Oklahoma National Head Quarters Supervisory Physician Walgreens Take Care Clinic 01/11-05/17 Walgreens, Chicago, Illinois Flight Surgeon 08/06-12/11 Air Ambulance Professionals, Ft. Lauderdale, Florida Emergency Medicine locum 09/07- 3/08 Pasco Regional Medical Center, Dade City, Florida Emergency Medicine Staff 09/06-1/08 Cedars Medical Center, Miami, Florida Emergency Medicine Locum 06/06-06/07 Shands at Lake Shore, Lake City, Florida Emergency Medicine Locum 01/05-06/07 Westchester General Hospital, Miami, Florida Emergency Medicine Locum 03/20/07-03/24/07 St. James Community Hospital, Butte, Montana Emergency Medicine Locum 12/29/06-12/31/06 Northern Montana Hospital, Havre, Montana Family Medicine Locum 12/02/06-12/08/06 Islands Community Medical Services, Inc., Vinalhaven, Maine Family Medicine Locum 04/06-08/06 Hana Health, Hana, Hawaii Hospitalist 12/05-04/06 West Boca Medical Center, Tenet South Florida, Boca Raton, Florida Emergency Medicine/Hospitalist Locum 06/05-09/05 Frankton Medical Center, Queenstown, New Zealand Michael James Hall, MD 1680 Meridian Avenue, Suite 601 Florida 33139 Phone: 305.672.4733 Fax: 305.672.4771 E-Mail: michael@hallongevity.com Professional Experience (continued) Emergency Medicine Locum 04/05-06/05 Accident and Emergency Services, White Cross Healthcare, Ltd. Auckland, New Zealand Emergency Medicine/General Practice Locum 09/04-03/05 Te Whare Hauroa O Te Hiku Maori Health Clinic, Kaitaia, New Zealand Emergency Medicine Medical Mission 12/04-01/05 St. John's American Ceylon Mission & St. John's Guest House, Batticaloa, Sri Lanka Co-founded a Tsunami Medical Relief general medical care mission sponsored by the New Zealand Ministry of Foreign Affairs and Trade Emergency Medicine Locum 05/03-05/04 Cameron Regional Medical Center, Cameron, Missouri Emergency Medicine Locum 02/03-09/03 Cass Medical Center, Harrisonville, Missouri Emergency Medicine Locum 02/03-02/04 Bates County Memorial Hospital, Butler, Missouri Staff Physician/Occupational Medicine 02/02-08/04 Kansas City Free Health Clinic, Kansas City, Missouri Executive Vice President/Co-Founder 05/01-05/02 Kansas City Health Systems, Inc., Lee's Summit, Missouri Medical Director/Internist/Substance Abuse Medicine 03/98-04/01 Lower Eastside Service Center, Inc., New York, New York Internist/ Occupational Medicine 10/97-04/01 Private Practice, New York, New York Michael James Hall, MD 1680 Meridian Avenue, Suite 601 Florida 33139 Phone: 305.672.4733 Fax: 305.672.4771 E-Mail: michael@hallongevity.com Medical Training Fellowship, Integrative and Functional Medicine 09/12-Present Miller School of Medicine, University of Miami, Miami, Florida Residency, Community and Family Medicine 05/02-08/04 Truman Medical Center-Lakewood, Kansas City, Missouri Rotation at Korowai Aroha Health Centre, Rotorua, New Zealand 02/04 Residency, Ophthalmology 07/95-10/97 The New York Presbyterian Hospital, New York, New York Internship, Internal Medicine 06/94-06/95 Alton Ochsner Medical Foundation, New Orleans, Louisiana Education Doctor of Allopathic Medicine 08/88-05/94 University of Missouri-Kansas City, School of Medicine Kansas City, Missouri Bachelor of Arts, Biology 08/88-12/92 University of Missouri-Kansas City, School of Basic Life Sciences Kansas City, Missouri Master of Science, Health Care Management and Policy 01/00-05/01 New York University, Robert F. Wagner Graduate School of Public Service New York, New York Military Experience US Air Force Reserve 2nd Lieutenant , Honorable Discharge 04/92 Licensure & Board Certification Active: Florida, Hawaii, Missouri, Montana, New Zealand Active: American Board of Family Medicine Certification 12/2014-12/2024 Michael James Hall, MD 1680 Meridian Avenue, Suite 601 Florida 33139 Phone: 305.672.4733 Fax: 305.672.4771 E-Mail: michael@hallongevity.com Certifications & Continuing Medical Education Current: BLS Diplomate, American Board of Family Medicine 2004 & 2014 FAA, Senior Airman Medical Examiner 2013 Suboxone DEA Waiver 2009 Professional Memberships Founder, New Zealand Medical Alliance Member, Air Medical Physician Association (AMPA) Publications "The Chivalrous Physician" 12/03 Family Practice Management Magazine, American Academy of Family Practice The American Gentleman A Contemporary Guide to Chivalry 08/02 Authorhouse; Bloomington, Indiana ISBN: 0759673659 "Physician Alliances: A Means for Total Quality Improvement in Health Care" 10/01 Submitted: Journal of the American Society of Law, Medicine and Ethics "Eye Opener", Editorial, Vogue Magazine 06/96