NPIMap

Organization Active NPI

South Broward Hospital District

Doing business as Memorial Division of High Risk Obstetrics

  • Obstetrics & Gynecology Physician
  • Hollywood, FL
National Provider Identifier
1003409301
Registry record updated Apr 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
SOUTH BROWARD HOSPITAL DISTRICT
Doing business as
Memorial Division of High Risk Obstetrics
Practice address
1150 N 35TH Ave Ste 560
Hollywood, FL 33021-5431
Phone
(954) 265-2740
Fax
(954) 276-0645
NPI assigned
Feb 17, 2021
Last updated
Apr 24, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH BROWARD HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 24, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Esther Surujon
Title
Cfo Memorial Physician Group MPC
Phone
(954) 265-6677

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

1150 N 35TH Ave Ste 560
Hollywood, FL 33021-5431

Mailing address

2900 Corporate Way
Door D
Miramar, FL 33025-3925
Phone (954) 276-5685

Other practice location 1

3501 Johnson St Fl 2
Hollywood, FL 33021-5421
Phone (954) 265-3441

Other names 1

  • Memorial Division of High Risk Obstetrics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210615000878 FL Part B Supplier - Clinic/Group Practice 8123927373 Receives reassigned benefits from 36 practitioners
Practice locations: Hollywood, FL

National Provider Directory

National Provider Directory
Tax ID family
Eddy H Carrillo MD58 organizations share this tax ID, including this one
Part of
Eddy H Carrillo MD

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

1150 N 35th Ave
Ste 245
Hollywood, FL 33021
Phone (954) 265-2740

3501 Johnson St
Fl 2
Hollywood, FL 33021
Phone (954) 265-3441

Networks

  • HealthSun Health Plans Network

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Memorial Hospital MiramarMiramar, FL, CCN 100285 Hospital Operational/Managerial Control
Other		 Mar 23, 2005
Mar 23, 2005
Memorial Regional HospitalHollywood, FL, CCN 100038 Hospital Operational/Managerial Control Jul 1, 1966
Memorial Rehabilitation InstituteHollywood, FL, CCN 10T038 Hospital Operational/Managerial Control Jun 1, 2017
Memorial Regional HospitalHollywood, FL, CCN 10S038 Hospital Operational/Managerial Control
Other		 Jan 1, 2016
Jan 1, 2020
Memorial Hospital WestPembroke Pines, FL, CCN 100281 Hospital Operational/Managerial Control
Other		 Feb 18, 2022
Oct 14, 2013
Memorial Hospital PembrokePembroke Pines, FL, CCN 100230 Hospital Operational/Managerial Control
Other		 Apr 1, 2020
Apr 1, 2020
Memorial Manor Nursing HomePembroke Pines, FL, CCN 105668 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jun 3, 1989
Jun 3, 1989

Practitioners & affiliated clinicians

Practitioners 36

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 36

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776988800000",
    "number": "1003409301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N 35TH AVE STE 560",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215431",
            "telephone_number": "954-265-2740",
            "fax_number": "954-276-0645"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3501 Johnson St Fl 2",
            "address_purpose": "LOCATION",
            "city": "Hollywood",
            "state": "FL",
            "postal_code": "330215421",
            "country_code": "US",
            "telephone_number": "954-265-3441",
            "fax_number": "954-368-0195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "enumeration_date": "2021-02-17",
        "last_updated": "2026-04-24",
        "certification_date": "2026-04-24",
        "status": "A",
        "authorized_official_last_name": "SURUJON",
        "authorized_official_first_name": "ESTHER",
        "authorized_official_title_or_position": "CFO MEMORIAL PHYSICIAN GROUP MPC",
        "authorized_official_telephone_number": "954-265-6677"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Division of High Risk Obstetrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.