NPIMap

Organization Active NPI

Douglas Gardens Community Mental Health Center of Miami Beach, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Miami Beach, FL
National Provider Identifier
1114991544
Registry record updated Aug 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
KH909 Issued in FL
Legal business name
DOUGLAS GARDENS COMMUNITY MENTAL HEALTH CENTER OF MIAMI BEACH, INC.
Practice address
1680 Meridian Ave
Suite 501
Miami Beach, FL 33139
Phone
(305) 531-5341
Fax
(305) 532-5322
NPI assigned
Feb 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2018

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

Authorized official

Name
Larry J Long, MACC
Title
Cfo
Phone
(305) 531-5341

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X KH909 FL
Case Management Agency 251B00000X KH909 FL
Community/Behavioral Health Agency 251S00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X KH909 FL Primary
Mental Illness Intermediate Care Facility 310500000X KH909 FL

Addresses

Primary practice location

1680 Meridian Ave
Suite 501
Miami Beach, FL 33139

Mailing address

1680 Meridian Ave Ste 501
Miami Beach, FL 33139-2719
Phone (305) 531-5341

Other practice location 1

1150 NE 125th St
North Miami, FL 33161-5019
Phone (305) 403-0654

Other practice location 2

1960 Park Ave
Miami Beach, FL 33139-1922
Phone (305) 604-3446

Other practice location 3

17000 NE 21st Ave
North Miami Beach, FL 33162-3308
Phone (305) 945-5340

Other identifiers 5

IdentifierTypeStateIssuer
060289200MedicaidFL
060289203MedicaidFL
090289204MedicaidFL
100730100MedicaidFL
060289201MedicaidFL

Other names 1

  • Douglas Gardens CMHC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041102000111 FL Part B Supplier - Clinic/Group Practice 1759343718 Receives reassigned benefits from 7 practitioners
Practice locations: Miami Beach, FL; North Miami, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2096594Douglas Gardens Community Mental Health Center1150 NE 125TH St, North Miami, FL 33161Certificate of waiverMay 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Douglas GDNS Com MTL HL3 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

1680 Meridian Ave
Ste 501
Miami Beach, FL 33139
Phone (305) 531-5341

1150 NE 125th St
North Miami, FL 33161
Phone (305) 403-0654

13390 W Dixie Hwy
North Miami, FL 33161
Phone (305) 403-0654

17000 NE 21st Ave
North Miami Beach, FL 33162
Phone (305) 945-5340

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534291200000",
    "number": "1114991544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1680 MERIDIAN AVE STE 501",
            "city": "MIAMI BEACH",
            "state": "FL",
            "postal_code": "331392719",
            "telephone_number": "305-531-5341",
            "fax_number": "305-532-5322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 MERIDIAN AVE",
            "address_2": "SUITE 501",
            "city": "MIAMI BEACH",
            "state": "FL",
            "postal_code": "33139",
            "telephone_number": "305-531-5341",
            "fax_number": "305-532-5322"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1150 NE 125th St",
            "address_purpose": "LOCATION",
            "city": "North Miami",
            "state": "FL",
            "postal_code": "331615019",
            "country_code": "US",
            "telephone_number": "305-403-0654",
            "fax_number": "305-403-0653",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1960 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Miami Beach",
            "state": "FL",
            "postal_code": "331391922",
            "country_code": "US",
            "telephone_number": "305-604-3446",
            "fax_number": "305-604-2018",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17000 NE 21st Ave",
            "address_purpose": "LOCATION",
            "city": "North Miami Beach",
            "state": "FL",
            "postal_code": "331623308",
            "country_code": "US",
            "telephone_number": "305-945-5340",
            "fax_number": "305-940-5468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DOUGLAS GARDENS COMMUNITY MENTAL HEALTH CENTER OF MIAMI BEACH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-14",
        "last_updated": "2018-08-15",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "305-531-5341",
        "authorized_official_credential": "MACC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "KH909",
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "FL",
            "license": "KH909",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "FL",
            "license": "KH909",
            "primary": true
        },
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "FL",
            "license": "KH909",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060289200",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060289203",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "090289204",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100730100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060289201",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Douglas Gardens CMHC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Douglas Gardens CMHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Miami Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.