NPIMap

Organization Active NPI

Nicklaus Children's Pediatric Specialists, LLC

  • Pediatrics Physician
  • Hialeah, FL
National Provider Identifier
1013577246
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC
Practice address
4410 W 16TH Ave Ste 60
Hialeah, FL 33012-7194
Phone
(305) 823-0721
Fax
(305) 823-2011
NPI assigned
Jun 19, 2019
Last updated
Nov 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Authorized official

Name
Laura M Gaber
Title
Provider Relations Specialist
Phone
(786) 624-5747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

4410 W 16TH Ave Ste 60
Hialeah, FL 33012-7194

Mailing address

3100 SW 62ND Ave
Miami, FL 33155-3009
Phone (305) 643-0133

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL payer.credentialing@mch.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170329002645 FL Part B Supplier - Clinic/Group Practice 5395020507 Receives reassigned benefits from 68 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Weston, FL; Plantation, FL; Palmetto Bay, FL; Palm City, FL; Miami, FL; Hialeah, FL; Fort Lauderdale, FL; Coral Springs, FL…

Other NPIs on the same Medicare enrollment 32

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 32

National Provider Directory

National Provider Directory
Tax ID family
Nicklaus Children's Pediatric Specialists LLC76 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1560902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730851200000",
    "number": "1013577246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SW 62ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331553009",
            "telephone_number": "305-643-0133",
            "fax_number": "305-643-1728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 W 16TH AVE STE 60",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330127194",
            "telephone_number": "305-823-0721",
            "fax_number": "305-823-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-19",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-05",
        "status": "A",
        "authorized_official_last_name": "GABER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROVIDER RELATIONS SPECIALIST",
        "authorized_official_telephone_number": "786-624-5747"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "payer.credentialing@mch.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4410 W 16th Ave Ste 60",
            "city": "Hialeah",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330127194",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.