NPIMap

Organization Active NPI

Primary Care and Educational Center of Miami

  • Primary Care Clinic/Center
  • Miami, FL
National Provider Identifier
1174995609
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
ARNP9231287 Issued in FL
Legal business name
PRIMARY CARE AND EDUCATIONAL CENTER OF MIAMI
Practice address
13205 SW 137TH Ave Ste 232-233
Miami, FL 33186-5331
Phone
(786) 290-9192
Fax
(800) 603-8893
NPI assigned
Oct 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Authorized official

Name
Eddy Marcial, ARNPNPI 1841694221
Title
President
Phone
(786) 290-9192

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X
Health Service Clinic/Center 261QH0100X ARNP9231287 FL
Adult Mental Health Clinic/Center 261QM0850X
Primary Care Clinic/Center 261QP2300X ARNP9231287 FL Primary

Addresses

Primary practice location

13205 SW 137TH Ave Ste 232-233
Miami, FL 33186-5331

Mailing address

13205 SW 137TH Ave # 224-225
Miami, FL 33186-5331
Phone (786) 290-9192

Other identifiers 3

IdentifierTypeStateIssuer
1841694221OtherFLNPI (PERSONAL)
016803600MedicaidFL
1174995609OtherFLNPI

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL 1174995609 Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170225000201 FL Part B Supplier - Clinic/Group Practice 5799069456 Receives reassigned benefits from 9 practitioners
Practice locations: Miami, FL

National Provider Directory

National Provider Directory

Locations

13205 SW 137th Ave
Ste 232233
Miami, FL 33186
Phone (786) 290-9192

13205 SW 137th Ave
Ste 224225
Miami, FL 33186
Phone (786) 290-9192

13205 SW 137th Ave
#224225
Miami, FL 33186

13205 SW 137th Ave
Ste 231
Miami, FL 33186
Phone (786) 280-4187

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1445558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1174995609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13205 SW 137TH AVE # 224-225",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331865331",
            "telephone_number": "786-290-9192",
            "fax_number": "786-603-8893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13205 SW 137TH AVE STE 232-233",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331865331",
            "telephone_number": "786-290-9192",
            "fax_number": "800-603-8893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE AND EDUCATIONAL CENTER OF MIAMI",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-23",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "MARCIAL",
        "authorized_official_first_name": "EDDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "786-290-9192",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "FL",
            "license": "ARNP9231287",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ARNP9231287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI (PERSONAL)",
            "identifier": "1841694221",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016803600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1174995609",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "1174995609",
            "affiliation": "N",
            "endpointDescription": "PRIMARY CARE & EDUCATIONAL CENTER OF MIAMI",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Health Care Clinic",
            "address_1": "13205 SW 137th Ave Ste 224-225",
            "city": "Miami",
            "state": "FL",
            "country_code": "US",
            "postal_code": "331865331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.