NPIMap

Organization Active NPI

Community Health of South Florida, Inc.

  • Federally Qualified Health Center (FQHC)
  • Florida City, FL
National Provider Identifier
1184887911
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH OF SOUTH FLORIDA, INC.
Practice address
19300 SW 376TH St
Florida City, FL 33034-6300
Phone
(305) 246-4607
NPI assigned
Jul 2, 2008
Last updated
Aug 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Authorized official

Name
Jeremy David Radziewicz
Title
Cfo
Phone
(305) 232-6047

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
General Practice Physician 208D00000X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

19300 SW 376TH St
Florida City, FL 33034-6300

Mailing address

10300 SW 216TH St
Miami, FL 33190-1003
Phone (305) 253-5100

Other identifiers 3

IdentifierTypeStateIssuer
029572809MedicaidFL
029572814MedicaidFL
060303104MedicaidFL

Other names 1

  • Everglades Health Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031114000182 FL Part A Provider - Federally Qualified Health Center (FQHC) 6507770526 Practice locations: Florida City, FL
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…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184887911. Details of each certification follow.

Federally qualified health center certification: CCN 101955

Legal name
COMMUNITY HEALTH OF SOUTH FLORIDA INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 8, 2004
Last certification
Jan 8, 2004
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 13, 1971 in FL
Enrollment address
19300 SW 376TH St
Florida City, FL 33034-6300
Related CCNs
101878

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 17

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 17

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Community Health of South Dade Inc57 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Locations

19300 SW 376th St
Florida City, FL 33034
Phone (305) 246-4607

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Linda Carmona-Sanchez Individual Corporate DirectorBoard of Director Mar 2, 2026
Natalie Windsor Individual Corporate DirectorBoard of Directors Jan 1, 2019
Paul Herdsman Individual Corporate DirectorBoard of Director Jan 1, 2019
Jeremy Radziewicz Individual Corporate DirectorVP of Finance Aug 6, 2018
W-2 Managing EmployeeVP of Finance Aug 6, 2018
Ingrid Mapelli- Franco Individual Corporate DirectorBoard of Director Mar 2, 2026
Andre Reid Individual Corporate DirectorBoard of Directors Jan 1, 2019
Carolyn Taylor-Pates Individual Corporate DirectorBoard of Directors Jan 1, 2013
Arjun Saluja Individual Corporate DirectorBoard of Directors Mar 2, 2026
Glen Smith Individual Corporate DirectorBoard of Director Mar 2, 2026
Carlo Saint Cy Individual Corporate DirectorBoard of Directors May 1, 2015
Claudia Guadalupe Gonzalez Individual Corporate DirectorBoard of Director Mar 2, 2026
Anthony B Hall Individual Corporate DirectorPresident/Ceo Jan 1, 2022
W-2 Managing EmployeePresident/Ceo Jan 1, 2022
Enrique Flores Individual Corporate DirectorBoard of Director Mar 2, 2026

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724889600000",
    "number": "1184887911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10300 SW 216TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331901003",
            "telephone_number": "305-253-5100",
            "fax_number": "305-254-4987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19300 SW 376TH ST",
            "city": "FLORIDA CITY",
            "state": "FL",
            "postal_code": "330346300",
            "telephone_number": "305-246-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH OF SOUTH FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A",
        "authorized_official_last_name": "RADZIEWICZ",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "305-232-6047"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029572809",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029572814",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060303104",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Everglades Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Florida City, FL

Sources for this page

Verify at the official NPI Registry.