NPIMap

Organization Active NPI

South Broward Hospital District

Doing business as Memorial Division of Pediatric Complex Care

  • Pediatrics Physician
  • Hollywood, FL
National Provider Identifier
1063013787
Registry record updated Oct 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SOUTH BROWARD HOSPITAL DISTRICT
Doing business as
Memorial Division of Pediatric Complex Care
Practice address
1005 Joe Dimaggio Dr
Pediatrics Floor 4
Hollywood, FL 33021-5402
Phone
(954) 265-6331
Fax
(954) 893-6244
NPI assigned
Nov 9, 2020
Last updated
Oct 3, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH BROWARD HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2025

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

Authorized official

Name
Esther Surujon
Title
Chief Financial Officer MPG and MPC
Phone
(954) 265-6677

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

1005 Joe Dimaggio Dr
Pediatrics Floor 4
Hollywood, FL 33021-5402

Mailing address

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

Other practice location 1

1971 SW 172nd Ave Ste 2500
Miramar, FL 33029-5621
Phone (954) 265-4494

Other names 1

  • Memorial Division of Pediatric Complex Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210201000320 FL Part B Supplier - Hospital Department(S) 8123927373 Receives reassigned benefits from 3 practitioners
Practice locations: Miramar, FL; Hollywood, FL

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Specialty Cen58 organizations share this tax ID, including this one
Part of
Pediatric Specialty Cen

Organizations with this tax ID in the same state 16

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

View all 16

Locations

1005 N 35th Ave
Fl 4
Hollywood, FL 33021
Phone (954) 265-5324

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 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1604880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759449600000",
    "number": "1063013787",
    "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": "1005 JOE DIMAGGIO DR",
            "address_2": "PEDIATRICS FLOOR 4",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215402",
            "telephone_number": "954-265-6331",
            "fax_number": "954-893-6244"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1971 SW 172nd Ave Ste 2500",
            "address_purpose": "LOCATION",
            "city": "Miramar",
            "state": "FL",
            "postal_code": "330295621",
            "country_code": "US",
            "telephone_number": "954-265-4494",
            "fax_number": "954-276-0702",
            "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": "2020-11-09",
        "last_updated": "2025-10-03",
        "certification_date": "2025-10-03",
        "status": "A",
        "authorized_official_last_name": "SURUJON",
        "authorized_official_first_name": "ESTHER",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER MPG AND MPC",
        "authorized_official_telephone_number": "954-265-6677"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Division of Pediatric Complex Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Memorial Division of Pediatric Complex Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.