Community Health of South Florida Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Perrine, FL
NPI 1164685673 · NPPES record last updated Aug 29, 2024
Key facts
- NPI
- 1164685673
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY HEALTH OF SOUTH FLORIDA INC
- Practice address
- 18255 Homestead Ave
Perrine, FL 33157-5564 - Phone
- (305) 252-4487
- NPI assigned
- Jul 3, 2008
- Organization subpart
- No
Authorized official
- Name
- Jeremy David Radziewicz
- Title
- Cfo
- Phone
- (305) 232-6047
Other NPIs on the same Medicare enrollment 17
Other NPIs with the same Medicare PAC ID 17
Corporate family (same tax ID) 19
Practitioners 60
-
Saint Anthony Amofah, M.D.
-
Nigel Molina, P.A.
-
Edwin Bosa-Osorio, M.D.
-
Shaquan Chambliss-Huggins, ARNP, MSN, FNP-C
-
Glenn Cooreman, MD
-
Cindy Cork, O.D.
-
Marcello De Carvalho, MSN, APRN, PMHNP-BC
-
Christopher Edouard, ARNP
-
Alexander J Fernandez, M.D.
-
Gloria Maria Gonzalez, APRN, NP-C
-
Jorge M. Gonzalez, BS, ARNP
-
Lorilee Agatha Graham, APRN
-
Edwin A Herrera, MD
-
Abida Hussain, PA
-
Tariku Menberu, ARNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL
Federally qualified health center certification: CCN 101898
- Legal name
- COMMUNITY HEALTH OF SOUTH FLORIDA INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 11, 1994
- Last certification
- May 11, 1994
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 13, 1971 in FL
- Enrollment address
- 18255 Homestead Ave
Perrine, FL 33157-5564
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Cesar Caicedo |
Corporate Director |
Jan 1, 2013 | |
| Natalie Windsor |
Corporate Director |
Jan 1, 2019 | |
| Paul Herdsman |
Corporate Director |
Jan 1, 2022 | |
| Jeremy Radziewicz |
Corporate Director |
Aug 6, 2015 | |
| W-2 Managing Employee |
Aug 6, 2018 | ||
| Jeffrey Coldren |
Corporate Director |
Jan 1, 2013 | |
| Andre Reid |
Corporate Director |
Jan 1, 2022 | |
| Jose Gancedo |
Corporate Director |
Jan 1, 2022 | |
| Carolyn Taylor-Pates |
Corporate Director |
Jan 1, 2008 | |
| Johnny Brown |
Corporate Director |
Jan 1, 2022 | |
| Carlo Saint Cy |
Corporate Director |
Jan 1, 2019 | |
| Anthony B Hall |
Corporate Director |
Jan 1, 2022 | |
| W-2 Managing Employee |
Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031118000460 | FL | Part B Supplier - Clinic/Group Practice | 6507770526 |
Receives reassigned benefits from 147 practitioners 17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tavernier, FL; Cutler Bay, FL; South Miami, FL; Perrine, FL; Naranja, FL; Miami, FL; Marathon, FL; Key West, FL… |
| O20040726000662 | FL | Part a Provider - Federally Qualified Health Center (FQHC) | 6507770526 | Practice locations: Perrine, FL |
National Provider Directory
- Tax ID family
- Community Health Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
18255 Homestead Ave
Perrine, FL 33157-5564
Mailing address
10300 SW 216TH St
Miami, FL 33190-1003
Phone (305) 253-5100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 053715201 | Medicaid | FL | |
| 029572804 | Medicaid | FL |
Other names
- West Perrine Health Center
Other providers in Perrine, FL
All providers in Perrine, FL · Federally Qualified Health Center (FQHC) in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.