NPIMap

Organization Active NPI

Evelyn Diagnostic & Medical Group Inc

  • General Practice Physician
  • Hialeah, FL
National Provider Identifier
1124220470
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
EVELYN DIAGNOSTIC & MEDICAL GROUP INC
Practice address
7000 W 12TH Ave
Suite 15
Hialeah, FL 33014-5154
Phone
(305) 512-1850
Fax
(305) 512-1851
NPI assigned
May 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2008

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

Authorized official

Name
Ernesto M Carralero, PA
Title
President
Phone
(305) 512-1850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

7000 W 12TH Ave
Suite 15
Hialeah, FL 33014-5154

Mailing address

7000 W 12TH Ave
Suite 15
Hialeah, FL 33014-5154
Phone (305) 512-1850

Other identifiers 1

IdentifierTypeStateIssuer
HCC5649OtherFLHEALTH CARE CLINIC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1124220470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7000 W 12TH AVE",
            "address_2": "SUITE 15",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330145154",
            "telephone_number": "305-512-1850",
            "fax_number": "305-512-1851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7000 W 12TH AVE",
            "address_2": "SUITE 15",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330145154",
            "telephone_number": "305-512-1850",
            "fax_number": "305-512-1851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVELYN DIAGNOSTIC & MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "CARRALERO",
        "authorized_official_first_name": "ERNESTO",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-512-1850",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH CARE CLINIC",
            "identifier": "HCC5649",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.