South Broward Hospital District

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

Legal business name

SOUTH BROWARD HOSPITAL DISTRICT

Doing business as

Memorial Division of Pediatric Interventional Cardiology

Practice address

1150 N 35TH Ave Ste 490
Hollywood, FL 33021-5423

Phone

(954) 265-3437

Fax

(954) 983-5052

NPI assigned

May 9, 2018

Last updated

Aug 31, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

SOUTH BROWARD HOSPITAL DISTRICTAs reported in NPPES

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

Authorized official

Name

Esther Surujon

Title

Cfo MPG, MPC and Ucc

Phone

(954) 265-6677

Specialties & licenses 1

Addresses

Other names 1

• Memorial Division of Pediatric Interventional Cardiology Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Part of

Memorial Hosp Div Ortho

Locations

All facility ownership & control disclosures 7

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

Practitioners 10

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.

• Thomas Joseph Forbes, MD

  • Pediatric Cardiology Physician
  • Detroit, MI
  • NPI 1538109020

  FL

  Medicare reassignment Care Compare group NPD
• Laura Bernal, PA-C

  • Physician Assistant
  • Hollywood, FL
  • NPI 1457131260
  Medicare reassignment NPD
• Brian Alan Boe, M.D.

  • Pediatric Cardiology Physician
  • Hollywood, FL
  • NPI 1043452378
  Medicare reassignment NPD
• Kak-Chen Chan, MD

  • Pediatric Cardiology Physician
  • Hollywood, FL
  • NPI 1124103866
  Medicare reassignment NPD
• Peter W. Guyon Jr., MD

  • Pediatric Cardiology Physician
  • Hollywood, FL
  • NPI 1205255510
  Medicare reassignment NPD
• Orhan Usame Kilinc, M.D.

  • Pediatric Cardiology Physician
  • Hollywood, FL
  • NPI 1205101326
  Medicare reassignment NPD
• Larry A Latson, MD

  • Pediatric Cardiology Physician
  • Hollywood, FL
  • NPI 1366538027
  Medicare reassignment NPD
• Ming-Lon Young, MD

  • Pediatric Cardiology Physician
  • Hollywood, FL
  • NPI 1043245913
  Medicare reassignment NPD
• Kelly Marie Murray, PA

  • Physician Assistant
  • Indianapolis, IN
  • NPI 1508343112

  FL

  Medicare reassignment NPD
• Ronald Allen Ligon Jr., M.D.

  • Pediatric Cardiology Physician
  • Stockbridge, GA
  • NPI 1073759379
  NPD

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

{
    "created_epoch": "1525824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693440000000",
    "number": "1164911764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N 35TH AVE STE 490",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215423",
            "telephone_number": "954-265-3437",
            "fax_number": "954-983-5052"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3501 Johnson St Fl 1",
            "address_purpose": "LOCATION",
            "city": "Hollywood",
            "state": "FL",
            "postal_code": "330215421",
            "country_code": "US",
            "telephone_number": "954-265-3437",
            "fax_number": "954-265-3731",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1971 SW 172nd Ave Ste 500",
            "address_purpose": "LOCATION",
            "city": "Miramar",
            "state": "FL",
            "postal_code": "330295592",
            "country_code": "US",
            "telephone_number": "954-265-3437",
            "fax_number": "954-265-3731",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3377 S State Road 7 Ste 100",
            "address_purpose": "LOCATION",
            "city": "Wellington",
            "state": "FL",
            "postal_code": "334498002",
            "country_code": "US",
            "telephone_number": "954-265-3437",
            "fax_number": "954-265-3731",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "enumeration_date": "2018-05-09",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A",
        "authorized_official_last_name": "SURUJON",
        "authorized_official_first_name": "ESTHER",
        "authorized_official_title_or_position": "CFO MPG, MPC AND UCC",
        "authorized_official_telephone_number": "954-265-6677"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Division of Pediatric Interventional Cardiology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Memorial Division of Pediatric Interventional Cardiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South Broward Hospital District (Memorial Division of Cardiac Electrophysiology)
• South Broward Hospital District (Memorial Division of Neurosurgery (Pediatrics and Adult))
• South Broward Hospital District (Memorial Regional Outpatient Pharmacy)
• South Broward Hospital District (Memorial Division of Immunology and Allergy)
• South Broward Hospital District (Memorial Primary Care Pharmacy)
• South Broward Hospital District (Memorial Division of Orthopaedic Surgery and Sports Medicine)
• South Broward Hospital District (Memorial Healthcare System)
• South Broward Hospital District (Memorial Division of Surgical Oncology)
• South Broward Hospital District (Memorial Division of Pediatric Neurosurgery)
• South Broward Hospital District (Memorial Division of Pediatric Dermatology)

• Interventional Cardiology Physician in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Interventional Cardiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.