NPIMap

Organization Active NPI

Public Health Trust of Miami Dade County Florida

Doing business as Jackson North Medical Center Psy

  • Psychiatric Hospital Unit
  • North Miami Beach, FL
National Provider Identifier
1013942432
Registry record updated Apr 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
3998 Issued in NU
Legal business name
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Doing business as
Jackson North Medical Center Psy
Practice address
160 NW 170TH St
North Miami Beach, FL 33169-5521
Phone
(305) 585-8957
Fax
(305) 585-5259
NPI assigned
Jul 12, 2006
Last updated
Apr 6, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2017

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

Authorized official

Name
Mr. Mark T Knight
Title
Chief Financial Officer
Phone
(305) 585-7979

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 3998 FL
Psychiatric Hospital Unit 273R00000X 3998 NU Primary

Addresses

Primary practice location

160 NW 170TH St
North Miami Beach, FL 33169-5521

Mailing address

PO Box 12493
Miami, FL 33101-2493
Phone (786) 466-8080

Other identifiers 1

IdentifierTypeStateIssuer
010042102MedicaidFL

Other names 1

  • Jackson North Medical Center Psy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111121000881 FL Part A Provider - Hospital 8628981925 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL; North Miami Beach, FL; Palmetto Bay, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013942432. Details of each certification follow.

Hospital certification: CCN 10S022

Legal name
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Organization structure
GovernmentNon-profit
Enrollment address
1611 NW 12TH Ave
Miami, FL 33136-1005
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

View all 23

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Jackson North Medical Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Myriam Torres Individual Corporate OfficerVP Revenue Cycle Management Nov 1, 2010
Corporate Director Nov 1, 2011
W-2 Managing EmployeeVP Revenue Cycle Management Nov 1, 2011
Operational/Managerial ControlVP Revenue Cycle Management Nov 1, 2011
Mark T Knight Individual Corporate OfficerEvp, Cfo Nov 1, 2010
Corporate Director Nov 1, 2010
W-2 Managing EmployeeEvp, Cfo Nov 1, 2010
Operational/Managerial ControlEvp, Cfo Nov 1, 2010
Carlos Migoya Individual Corporate OfficerCeo May 2, 2011
Corporate DirectorCeo May 2, 2011
W-2 Managing EmployeeCeo May 2, 2011

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491436800000",
    "number": "1013942432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12493",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331012493",
            "telephone_number": "786-466-8080",
            "fax_number": "305-355-5380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 NW 170TH ST",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331695521",
            "telephone_number": "305-585-8957",
            "fax_number": "305-585-5259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2017-04-06",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "305-585-7979",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "FL",
            "license": "3998",
            "primary": false
        },
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NU",
            "license": "3998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010042102",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson North Medical Center Psy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Miami Beach, FL

Sources for this page

Verify at the official NPI Registry.