NPIMap

Organization Active NPI

Centers of Medical Excellence, LLC

  • General Practice Physician
  • Hialeah, FL
National Provider Identifier
1073196986
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CENTERS OF MEDICAL EXCELLENCE, LLC
Practice address
1738 W 49TH St Ste 10
Hialeah, FL 33012-3457
Phone
(305) 698-8432
Fax
(305) 698-8975
NPI assigned
Apr 29, 2021
Last updated
Apr 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Authorized official

Name
Sadita Bustamante
Title
Coo
Phone
(305) 874-3909

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

1738 W 49TH St Ste 10
Hialeah, FL 33012-3457

Mailing address

7925 NW 12TH St Ste 201
Doral, FL 33126-1821
Phone (305) 874-3909

Other practice location 1

1176 SW 67th Ave
Miami, FL 33144-4700
Phone (305) 874-3909

Other practice location 2

5850 W Flagler St
Miami, FL 33144-3363
Phone (305) 263-9590

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210526002394 FL Part B Supplier - Clinic/Group Practice 9739588666 Receives reassigned benefits from 34 practitioners
Practice locations: Miami Lakes, FL; Miami, FL; Homestead, FL; Hollywood, FL; Hialeah, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2147961Centers of Medical Excellence, LLC5850 West Flagler St, Miami, FL 33144Certificate of waiverApr 30, 2028
10D2225809Centers of Medical Excellence, LLC1176 SW 67TH Avenue, Miami, FL 33144Certificate of waiverMay 24, 2027
10D2227557Centers of Medical Excellence,LLC1738 W 49TH Street, Unit 10, Hialeah, FL 33012Certificate of waiverJun 13, 2027

National Provider Directory

National Provider Directory

Locations

1390 NW 7th St
Miami, FL 33125
Phone (305) 548-3301

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1619654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619654400000",
    "number": "1073196986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7925 NW 12TH ST STE 201",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331261821",
            "telephone_number": "305-874-3909",
            "fax_number": "305-874-3916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1738 W 49TH ST STE 10",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330123457",
            "telephone_number": "305-698-8432",
            "fax_number": "305-698-8975"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1176 SW 67th Ave",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331444700",
            "country_code": "US",
            "telephone_number": "305-874-3909",
            "fax_number": "305-874-3916",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5850 W Flagler St",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331443363",
            "country_code": "US",
            "telephone_number": "305-263-9590",
            "fax_number": "305-263-9657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTERS OF MEDICAL EXCELLENCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-29",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-23",
        "status": "A",
        "authorized_official_last_name": "BUSTAMANTE",
        "authorized_official_first_name": "SADITA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "305-874-3909"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Apr 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.