NPIMap

Organization Active NPI

Public Health Trust of Miami Dade County Florida

Doing business as Jackson North Medical Center

  • General Acute Care Hospital
  • North Miami Beach, FL
National Provider Identifier
1104857119
Registry record updated Apr 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
3998 Issued in FL
Legal business name
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Doing business as
Jackson North Medical Center
Practice address
160 NW 170TH St
North Miami Beach, FL 33169-5521
Phone
(305) 585-8957
Fax
(305) 585-5259
NPI assigned
Jul 6, 2006
Last updated
Apr 6, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2017

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

Authorized official

Name
Mr. Mark T Knight
Title
Exec. VP, Chief Financial Officer
Phone
(305) 585-7979

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 3998 FL Primary

Addresses

Primary practice location

160 NW 170TH St
North Miami Beach, FL 33169-5521

Mailing address

PO Box 12493
Miami, FL 33101-2493
Phone (786) 466-8080

Other identifiers 1

IdentifierTypeStateIssuer
010042102MedicaidFL

Other names 1

  • Jackson North Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20060208000214 FL Part A Provider - Hospital 8628981925 22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL; North Miami Beach, FL; Miami Beach, FL; North Miami, FL; Opa Locka, FL; Village of Palmetto Bay, FL; Homestead, FL; Doral, FL…
O20120514000120 FL Part B Supplier - Clinic/Group Practice 5597928432 Receives reassigned benefits from 20 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL; North Miami Beach, FL
O20140326001597 FL Part B Supplier - Clinic/Group Practice 4688805179 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL; North Miami Beach, FL; Palmetto Bay, FL
O20211117000622 FL Part B Supplier - Clinic/Group Practice 0547659336 Receives reassigned benefits from 13 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL; Plantation, FL; North Miami Beach, FL; Coral Gables, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104857119. Details of each certification follow.

Hospital certification: CCN 100022

Legal name
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 9, 2020
Beds
2,255
Ownership / control type
Hospital district or authority
Organization structure
GovernmentNon-profit
Enrollment address
1611 NW 12TH Ave
Miami, FL 33136-1005
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 25

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

View all 25

Care Compare: Hospital

Medicare Care Compare
Listed as
Jackson Health SystemCCN 100022 · All quality measures
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Jackson North Medical Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

9380 SW 150th St
Ste 210
Miami, FL 33176
Phone (305) 256-5018

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • HealthSun Health Plans Network
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Myriam Torres Individual Corporate OfficerVP Revenue Cycle Management Mar 21, 2016
Corporate DirectorVP Revenue Cycle Management Mar 21, 2016
W-2 Managing EmployeeVP Revenue Cycle Management Mar 21, 2016
Operational/Managerial ControlVP Revenue Cycle Management Mar 21, 2016
Mark T Knight Individual Corporate OfficerEvp, Chief Financial Officer Nov 1, 2010
Corporate DirectorEvp, Chief Financial Officer Nov 1, 2011
W-2 Managing EmployeeEvp, Chief Financial Officer Nov 1, 2010
Operational/Managerial ControlEvp, Chief Financial Officer Nov 1, 2011
Carlos Migoya Individual Corporate OfficerChief Executive Officer May 2, 2011
Corporate DirectorChief Executive Officer May 2, 2011
W-2 Managing EmployeeChief Executive Officer May 2, 2011
Operational/Managerial ControlChief Executive Officer May 2, 2011
Public Health Trust of Miami Dade County Florida Organization, Miami, FL Non-profit Operational/Managerial Control Oct 1, 1973 100%

Owners & managing parties with NPI records 12

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

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

Affiliated clinicians 1,674

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,674

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491436800000",
    "number": "1104857119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12493",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331012493",
            "telephone_number": "786-466-8080",
            "fax_number": "305-355-2377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 NW 170TH ST",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331695521",
            "telephone_number": "305-585-8957",
            "fax_number": "305-585-5259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2017-04-06",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "EXEC. VP, CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "305-585-7979",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "FL",
            "license": "3998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010042102",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson North Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Miami Beach, FL

Sources for this page

Verify at the official NPI Registry.