NPIMap

Organization Active NPI

Banyan Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Coral Gables, FL
National Provider Identifier
1104247188
Registry record updated Apr 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BANYAN COMMUNITY HEALTH CENTER, INC.
Practice address
3733 W Flagler St
Coral Gables, FL 33134-1601
Phone
(305) 398-6100
Fax
(305) 398-6099
NPI assigned
Dec 18, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2025

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

Authorized official

Name
Manuel Andres Fernandez
Title
Ceo
Phone
(561) 213-9211

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3733 W Flagler St
Coral Gables, FL 33134-1601

Mailing address

2300 NW 89TH PL FL 3
Doral, FL 33172-2431
Phone (305) 398-6100

Other identifiers 3

IdentifierTypeStateIssuer
013881901MedicaidFL
013881911MedicaidFL
013881900MedicaidFL

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121017000910 FL Part B Supplier - Clinic/Group Practice 0547410011 Receives reassigned benefits from 41 practitioners
4 other NPIs on this enrollment
Practice locations: Lauderdale Lakes, FL; Cutler Bay, FL; Coral Gables, FL
O20150409000694 FL Part A Provider - Federally Qualified Health Center (FQHC) 0547410011 Practice locations: Coral Gables, FL

Federally qualified health center certification: CCN 681013

Legal name
BANYAN COMMUNITY HEALTH CENTER, INC
Doing business as
BANYAN HEALTH SYSTEMS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 9, 2015
Last certification
Apr 9, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 30, 2010 in FL
Enrollment address
3733 W Flagler St
Coral Gables, FL 33134-1601

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Networks

  • HealthSun Health Plans Network

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Banyan Community Health Center, Inc Organization, Doral, FL Corporation 5% Or Greater Direct Ownership Interest Dec 29, 2014 100%
Manuel Fernandez Individual Corporate OfficerChief Executive Officer Sep 26, 2024
Corporate DirectorPresident, Chief Executive Offic Feb 1, 2024
W-2 Managing Employee Sep 26, 2024

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Banyan Health Systems, Inc.Coral Gables, FL, CCN 681011 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 30, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1387324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744675200000",
    "number": "1104247188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 NW 89TH PL FL 3",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331722431",
            "telephone_number": "305-398-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3733 W FLAGLER ST",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331341601",
            "telephone_number": "305-398-6100",
            "fax_number": "305-398-6099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANYAN COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-18",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "ANDRES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-213-9211"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013881901",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013881911",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013881900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coral Gables, FL

Sources for this page

Verify at the official NPI Registry.