NPIMap

Organization Active NPI

Children's Medical Center, PA.

  • Exclusive Provider Organization
  • Pembroke Pines, FL
National Provider Identifier
1184842395
Registry record updated Sep 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
License
ME5015 Issued in FL
Legal business name
CHILDREN'S MEDICAL CENTER, PA.
Practice address
20170 Pines Blvd
Suite 203
Pembroke Pines, FL 33029-1259
Phone
(954) 378-1500
Fax
(954) 378-1530
NPI assigned
Apr 23, 2007
Last updated
Sep 19, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2011

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

Authorized official

Name
Theodore Morrison, M.D.NPI 1134111313
Title
President
Phone
(954) 989-6000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X ME5015 FL Primary

Addresses

Primary practice location

20170 Pines Blvd
Suite 203
Pembroke Pines, FL 33029-1259

Mailing address

20170 Pines Blvd
Suite 203
Pembroke Pines, FL 33029-1259
Phone (954) 378-1500

Other identifiers 1

IdentifierTypeStateIssuer
060425902MedicaidFL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0965870Children's Medical Center of South Florida, LLC20170 Pines Boulevard Suite 203, Pembroke Pines, FL 33029AccreditationApr 13, 2028

National Provider Directory

National Provider Directory
Tax ID family
Children's Medical Center PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12251 Taft St
Ste 201
Pembroke Pines, FL 33026
Phone (954) 435-7000

20170 Pines Blvd
Ste 203
Pembroke Pines, FL 33029
Phone (954) 378-1500

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316390400000",
    "number": "1184842395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20170 PINES BLVD",
            "address_2": "SUITE 203",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330291259",
            "telephone_number": "954-378-1500",
            "fax_number": "954-378-1530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20170 PINES BLVD",
            "address_2": "SUITE 203",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330291259",
            "telephone_number": "954-378-1500",
            "fax_number": "954-378-1530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S MEDICAL CENTER, PA.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2011-09-19",
        "status": "A",
        "authorized_official_last_name": "MORRISON",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-989-6000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "FL",
            "license": "ME5015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060425902",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.