NPIMap

Organization Active NPI

Community Health of South Florida, Inc.

  • Federally Qualified Health Center (FQHC)
  • Florida City, FL
National Provider Identifier
1104071232
Registry record updated Sep 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH OF SOUTH FLORIDA, INC.
Practice address
364 NW 6TH Ave
Florida City, FL 33034-3216
Phone
(305) 247-4676
NPI assigned
Nov 17, 2008
Last updated
Sep 19, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2013

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

Authorized official

Name
Brodes H Hartley Jr.
Title
Ceo
Phone
(305) 253-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

364 NW 6TH Ave
Florida City, FL 33034-3216

Mailing address

10300 SW 216TH St
Miami, FL 33190-1003
Phone (305) 253-5100

Other names 1

  • Florida City Elementary Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118000460 FL Part B Supplier - Clinic/Group Practice 6507770526 Receives reassigned benefits from 147 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tavernier, FL; Cutler Bay, FL; South Miami, FL; Perrine, FL; Naranja, FL; Miami, FL; Marathon, FL; Key West, FL…
O20090302000532 FL Part A Provider - Federally Qualified Health Center (FQHC) 6507770526 Practice locations: Florida City, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104071232. Details of each certification follow.

Federally qualified health center certification: CCN 101008

Legal name
COMMUNITY HEALTH OF SOUTH FLORIDA INC
Organization structure
CorporationNon-profit
Incorporated
Oct 13, 1971 in FL
Enrollment address
364 NW 6TH Avenue
Florida City, FL 33034-3216

Other NPIs with the same Medicare PAC ID 17

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 17

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Community Health Inc57 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

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

View all 15

Locations

364 NW 6th Ave
Florida City, FL 33034
Phone (305) 247-4676

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Cesar Caicedo Individual Corporate DirectorBoard of Directors Jan 1, 2022
Natalie Windsor Individual Corporate DirectorBoard of Directors Jan 1, 2022
Paul Herdsman Individual Corporate DirectorBoard of Directors Jan 1, 2022
Jeremy Radziewicz Individual Corporate DirectorCfo Aug 6, 2018
Jeffrey Coldren Individual Corporate DirectorBoard of Directors Jan 1, 2022
Andre Reid Individual Corporate DirectorBoard of Directors Jan 1, 2022
Carolyn Taylor-Pates Individual Corporate DirectorBoard of Directors Jan 1, 2022
Johnny Brown Individual Corporate DirectorBoard of Directors Jan 1, 2015
Carlo Saint Cy Individual Corporate DirectorBoard of Directors Jan 1, 2022
Anthony B Hall Individual Corporate DirectorPresident/Ceo Jan 1, 2022
W-2 Managing EmployeePresident/Ceo Jan 1, 2022

NPI Registry JSON

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

{
    "created_epoch": "1226880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379548800000",
    "number": "1104071232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10300 SW 216TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331901003",
            "telephone_number": "305-253-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "364 NW 6TH AVE",
            "city": "FLORIDA CITY",
            "state": "FL",
            "postal_code": "330343216",
            "telephone_number": "305-247-4676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH OF SOUTH FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-17",
        "last_updated": "2013-09-19",
        "status": "A",
        "authorized_official_last_name": "HARTLEY",
        "authorized_official_first_name": "BRODES",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-253-5100",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida City Elementary",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Florida City, FL

Sources for this page

Verify at the official NPI Registry.