NPIMap

Organization Active NPI

North Broward Hospital District

Doing business as Cdla Adult Clinic

  • Federally Qualified Health Center (FQHC)
  • Fort Lauderdale, FL
National Provider Identifier
1134512650
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTH BROWARD HOSPITAL DISTRICT
Doing business as
Cdla Adult Clinic
Clinica de las Americas
Practice address
1101 NW 1St St
Fort Lauderdale, FL 33311-8905
Phone
(954) 761-1020
Fax
(954) 761-9983
NPI assigned
Mar 9, 2015
Last updated
May 27, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTH BROWARD HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Authorized official

Name
Alisa Bert
Title
Cfo
Phone
(954) 847-4117

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1101 NW 1St St
Fort Lauderdale, FL 33311-8905

Mailing address

1700 NW 49TH St Ste 125
Fort Lauderdale, FL 33309-3750
Phone (954) 761-1020

Other names 2

  • CDLA ADULT CLINIC Doing business as
  • Clinica de las Americas Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040405001860 FL Part B Supplier - Clinic/Group Practice 3577472422 Receives reassigned benefits from 251 practitioners
This NPI is an additional NPI on the enrollment
O20210701002774 FL Part A Provider - Federally Qualified Health Center (FQHC) 3577472422 Practice locations: Fort Lauderdale, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134512650. Details of each certification follow.

Federally qualified health center certification: CCN 681884

Legal name
NORTH BROWARD HOSPITAL DISTRICT
Doing business as
CLINICA DE LAS AMERICAS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 2021
Last certification
Jul 1, 2021
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Jan 6, 2004 in FL
Enrollment address
1101 NW 1St St
Fort Lauderdale, FL 33311-8905

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
NBHD Imperial Point Med140 organizations share this tax ID, including this one
Part of
NBHD Imperial Point Med

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

201 E Sample Rd
Fl 1
Deerfield Beach, FL 33064
Phone (954) 786-7392

Networks

  • HealthSun Health Plans Network

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Stuart M Glassberg Individual Corporate OfficerReimbursement Manager Jun 28, 2010
Nancy Gregoire Individual Corporate OfficerBoard Member Dec 1, 2017
Stacy Angier Individual Corporate OfficerBoard Member Oct 19, 2018
Ray Berry Individual Corporate OfficerBoard Member May 11, 2018
Marie Waugh Individual Corporate OfficerBoard Member Nov 30, 2018
Levi Williams Individual Corporate OfficerBoard Member Apr 2, 2021
Alexander Fernandez Individual Corporate OfficerCfo Dec 23, 2018
Corporate DirectorCfo Dec 23, 2018
Operational/Managerial ControlCfo Dec 23, 2018
Shane Strum Individual Corporate OfficerCeo Mar 29, 2021
Corporate DirectorCeo Mar 29, 2021
Operational/Managerial ControlCeo Mar 29, 2021
Christopher Pernicano Individual Corporate OfficerBoard Member Apr 2, 2021
Jonathan Hage Individual Corporate OfficerBoard Member Apr 2, 2021

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
Broward Health NorthDeerfield Beach, FL, CCN 100086 Hospital Operational/Managerial Control May 14, 2008
Broward Health Imperial PointFort Lauderdale, FL, CCN 100200 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1984
Jan 1, 1984
Broward Health Medical Center-Psych UnitFort Lauderdale, FL, CCN 10S039 Hospital Operational/Managerial Control Jul 1, 2007
Broward Health Coral SpringsCoral Springs, FL, CCN 100276 Hospital Operational/Managerial Control (100%) Mar 17, 1987
Broward Health Imperial Point-Psych UnitFort Lauderdale, FL, CCN 10S200 Hospital Operational/Managerial Control (100%) Jul 1, 1984
Broward Health North- Rehab UnitDeerfield Beach, FL, CCN 10T086 Hospital Operational/Managerial Control May 13, 2008
Pompano Adult Primary CarePompano Beach, FL, CCN 101840 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 1993
Oct 1, 1993
Specialty Care CenterFort Lauderdale, FL, CCN 101841 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 1993
Jul 1, 1993
Margate Health CenterMargate, FL, CCN 681892 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 1993
Oct 1, 1993

Owned or controlled facilities with NPI records 11

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

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1425859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1134512650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 NW 49TH ST STE 125",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333093750",
            "telephone_number": "954-761-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 NW 1ST ST",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333118905",
            "telephone_number": "954-761-1020",
            "fax_number": "954-761-9983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BROWARD HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH BROWARD HOSPITAL DISTRICT",
        "enumeration_date": "2015-03-09",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A",
        "authorized_official_last_name": "BERT",
        "authorized_official_first_name": "ALISA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "954-847-4117"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CDLA ADULT CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinica de las Americas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.