NPIMap

Organization Active NPI

Miami Breast Center LLC

  • Specialist
  • Key Biscayne, FL
National Provider Identifier
1063726099
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MIAMI BREAST CENTER LLC
Practice address
580 Crandon Blvd
1St Floor
Key Biscayne, FL 33149-1832
Phone
(305) 365-5595
NPI assigned
Aug 2, 2010
Last updated
Jul 26, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2022

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

Authorized official

Name
Roger K Khouri, MDNPI 1740232784
Title
Owner
Phone
(305) 365-5595

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

580 Crandon Blvd
1St Floor
Key Biscayne, FL 33149-1832

Mailing address

580 Crandon Blvd
1St Floor
Key Biscayne, FL 33149-1832
Phone (305) 365-5595

Other practice location 1

6050 S Dixie Hwy
South Miami, FL 33143-5042
Phone (305) 365-5595

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110401000262 FL Part B Supplier - Clinic/Group Practice 3678756467 Receives reassigned benefits from 17 practitioners
Practice locations: Key Biscayne, FL

National Provider Directory

National Provider Directory

Locations

580 Crandon Blvd
Fl 1
Key Biscayne, FL 33149
Phone (305) 365-5595

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1280707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658793600000",
    "number": "1063726099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 CRANDON BLVD",
            "address_2": "1ST FLOOR",
            "city": "KEY BISCAYNE",
            "state": "FL",
            "postal_code": "331491832",
            "telephone_number": "305-365-5595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 CRANDON BLVD",
            "address_2": "1ST FLOOR",
            "city": "KEY BISCAYNE",
            "state": "FL",
            "postal_code": "331491832",
            "telephone_number": "305-365-5595"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6050 S Dixie Hwy",
            "address_purpose": "LOCATION",
            "city": "South Miami",
            "state": "FL",
            "postal_code": "331435042",
            "country_code": "US",
            "telephone_number": "305-365-5595",
            "fax_number": "305-365-5516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIAMI BREAST CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-02",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A",
        "authorized_official_last_name": "KHOURI",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-365-5595",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Key Biscayne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2022; 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.