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Organization Active NPI

Nicklaus Children's Pediatric Specialists, LLC

Doing business as Nicklaus Children's Pediatric Specialists at Plantation

  • Pediatrics Physician
  • Plantation, FL
National Provider Identifier
1144891045
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC
Doing business as
Nicklaus Children's Pediatric Specialists at Plantation
Practice address
8430 W Broward Blvd Ste 300
Plantation, FL 33324-2700
Phone
(954) 385-6277
Fax
(954) 217-6317
NPI assigned
Jul 2, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Authorized official

Name
Marcos Mestre
Title
SVP
Phone
(305) 666-6511

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Pediatric Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0202X
Pediatric Endocrinology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0205X
Pediatric Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0206X
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X

Addresses

Primary practice location

8430 W Broward Blvd Ste 300
Plantation, FL 33324-2700

Mailing address

3100 SW 62ND Ave
Miami, FL 33155-3009
Phone (954) 385-6277

Other names 1

  • Nicklaus Children's Pediatric Specialists at Plantation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170329002645 FL Part B Supplier - Clinic/Group Practice 5395020507 Receives reassigned benefits from 68 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Weston, FL; Plantation, FL; Palmetto Bay, FL; Palm City, FL; Miami, FL; Hialeah, FL; Fort Lauderdale, FL; Coral Springs, FL…

Other NPIs on the same Medicare enrollment 32

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

View all 32

National Provider Directory

National Provider Directory
Tax ID family
Variety Children's Hospital76 organizations share this tax ID, including this one

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

NPI Registry JSON

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

{
    "created_epoch": "1625184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1144891045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SW 62ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331553009",
            "telephone_number": "954-385-6277",
            "fax_number": "954-217-6317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8430 W BROWARD BLVD STE 300",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333242700",
            "telephone_number": "954-385-6277",
            "fax_number": "954-217-6317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-02",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "MESTRE",
        "authorized_official_first_name": "MARCOS",
        "authorized_official_title_or_position": "SVP",
        "authorized_official_telephone_number": "305-666-6511"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nicklaus Children's Pediatric Specialists at Plantation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nicklaus Children's Pediatric Specialists at Plantation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plantation, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.