NPIMap

Organization Active NPI

South Broward Hospital District

Doing business as Memorial Division of Cardiac Electrophysiology

  • Clinical Cardiac Electrophysiology Physician
  • Hollywood, FL
National Provider Identifier
1104229236
Registry record updated Oct 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
Legal business name
SOUTH BROWARD HOSPITAL DISTRICT
Doing business as
Memorial Division of Cardiac Electrophysiology
Practice address
1150 N 35TH Ave
Suite 605
Hollywood, FL 33021-5424
Phone
(954) 265-6939
Fax
(954) 265-6405
NPI assigned
Oct 3, 2014
Last updated
Oct 15, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2014

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

Authorized official

Name
Nina Beauchesne
Title
Sr Vice President MHS
Phone
(954) 265-6996

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0001X Primary

Addresses

Primary practice location

1150 N 35TH Ave
Suite 605
Hollywood, FL 33021-5424

Mailing address

2900 Corporate Way
MPG Door D
Miramar, FL 33025-3925
Phone (954) 276-5581

Other names 1

  • MEMORIAL DIVISION OF CARDIAC ELECTROPHYSIOLOGY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140319001324 FL Part B Supplier - Clinic/Group Practice 8123927373 Receives reassigned benefits from 79 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Weston, FL; Pembroke Pines, FL; Hollywood, FL; Hialeah, FL; Aventura, FL; Miramar, FL

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Eddy H Carrillo MD58 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

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

View all 18

Locations

1150 N 35th Ave
Ste 600
Hollywood, FL 33021
Phone (954) 265-5969

Networks

  • HealthSun Health Plans Network

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": "1412294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413331200000",
    "number": "1104229236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "MPG DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5581",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N 35TH AVE",
            "address_2": "SUITE 605",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215424",
            "telephone_number": "954-265-6939",
            "fax_number": "954-265-6405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-03",
        "last_updated": "2014-10-15",
        "status": "A",
        "authorized_official_last_name": "BEAUCHESNE",
        "authorized_official_first_name": "NINA",
        "authorized_official_title_or_position": "SR VICE PRESIDENT MHS",
        "authorized_official_telephone_number": "954-265-6996"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEMORIAL DIVISION OF CARDIAC ELECTROPHYSIOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollywood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; 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.