Individual provider Active NPI

Susan Tome-Manjarrez, ARNP

  • Adult Health Nurse Practitioner
  • Miami, FL
National Provider Identifier
1104996461
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN2683952 Issued in FL
Practice address
1611 NW 12TH Ave
Miami, FL 33136-1005
Phone
(305) 585-2708
NPI assigned
Nov 8, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X 2683952 FL
Adult Health Nurse Practitioner 363LA2200X APRN2683952 FL Primary

Addresses

Primary practice location

1611 NW 12TH Ave
Miami, FL 33136-1005

Mailing address

3813 SW 165TH Ter
Miramar, FL 33027-4618
Phone (305) 585-2708

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180912003577 FL Practitioner - Nurse Practitioner 0143570135 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Public Health Trust of Miami Dade County FloridaGroup PAC ID 1759432362, 132 clinicians

Practice addresses (Care Compare)

1611 NW 12 Ave
Miami, FL 33136-1005
Phone (305) 585-7110

Merit-based Incentive Payment System (MIPS)

Final score
93.42 of 100Reported as group
Quality
81.82
Promoting interoperability
79
Improvement activities
40
Cost
80.43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2683952FLMDNurse Practitioner
APRN2683952FLMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Public Health Trust of Miami Dade County Florida Single Specialty CurrentSince Jan 1, 2023 Accepting new patients
Public Health Trust of Miami Dade County Florida Single Specialty CurrentSince May 23, 2018 Accepting new patients
Public Health Trust of Miami Dade County Florida CurrentSince Jan 1, 2023 Accepting new patients
Public Health Trust of Miami Dade County Florida Current Accepting new patients

Locations

18910 S Dixie Hwy
Cutler Bay, FL 33157
Phone (305) 585-9230

1611 NW 12th Ave
Miami, FL 33136
Phone (305) 585-6226

13120 Biscayne Blvd
North Miami, FL 33181
Phone (305) 355-8234

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1104996461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3813 SW 165TH TER",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330274618",
            "telephone_number": "305-585-2708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 NW 12TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331361005",
            "telephone_number": "305-585-2708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOME-MANJARREZ",
        "first_name": "SUSAN",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "2683952",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN2683952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.