NPIMap

Organization Active NPI

Millenium Medical Group Corp.

  • Adult Medicine Physician
  • Miami, FL
National Provider Identifier
1093287377
Registry record updated Mar 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
MILLENIUM MEDICAL GROUP CORP.
Practice address
2720 SW 97TH Ave Ste C105
Miami, FL 33165-2677
Phone
(786) 332-4330
Fax
(786) 332-4109
NPI assigned
Dec 26, 2018
Last updated
Mar 6, 2025By the provider in NPPES
Organization subpart
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2025

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

Authorized official

Name
Damarys Quiriello
Title
President
Phone
(786) 332-4330

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Clinical Social Worker 1041C0700X NU
Adult Medicine Physician 207QA0505X NU Primary
Psychiatry Physician 2084P0800X NU
Clinic/Center 261Q00000X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

2720 SW 97TH Ave Ste C105
Miami, FL 33165-2677

Mailing address

2720 SW 97TH Ave Ste C105
Miami, FL 33165-2677
Phone (786) 332-4330

Other identifiers 1

IdentifierTypeStateIssuer
023735400MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180416002781 FL Part B Supplier - Clinic/Group Practice 1355604877 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Millenium Medical Group Corp3 organizations share this tax ID, including this one
Part of
Millenium Medical Group Corp

Other organizations with this tax ID 2

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

Locations

2720 SW 97th Ave
Ste C105
Miami, FL 33165
Phone (786) 332-4330

2740 SW 97th Ave
Apt 111A
Miami, FL 33165
Phone (786) 332-4330

Practitioners & affiliated clinicians

Practitioners 9

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": "1545782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741219200000",
    "number": "1093287377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2720 SW 97TH AVE STE C105",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331652677",
            "telephone_number": "786-332-4330",
            "fax_number": "786-332-4109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 SW 97TH AVE STE C105",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331652677",
            "telephone_number": "786-332-4330",
            "fax_number": "786-332-4109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLENIUM MEDICAL GROUP CORP.",
        "organizational_subpart": "YES",
        "enumeration_date": "2018-12-26",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A",
        "authorized_official_last_name": "QUIRIELLO",
        "authorized_official_first_name": "DAMARYS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "786-332-4330"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023735400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; 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.