NPIMap

Organization Active NPI

North Broward Hospital District

Doing business as Broward General Medical Center

  • General Acute Care Hospital
  • Fort Lauderdale, FL
National Provider Identifier
1184899452
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
4128 Issued in FL
Legal business name
NORTH BROWARD HOSPITAL DISTRICT
Doing business as
Broward General Medical Center
Practice address
1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510
Phone
(954) 847-4315
Fax
(954) 847-4270
NPI assigned
Apr 28, 2008
Last updated
May 10, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTH BROWARD HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
Alisa Bert
Title
Interim Cfo
Phone
(954) 847-4117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 4128 FL Primary

Addresses

Primary practice location

1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510

Mailing address

PO Box 932540
Atlanta, GA 31193-2540
Phone (954) 847-4315

Other names 1

  • Broward General Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210728002238 FL Part A Provider - Federally Qualified Health Center (FQHC) 3577472422 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Lauderdale, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184899452. Details of each certification follow.

Federally qualified health center certification: CCN 681888

Legal name
NORTH BROWARD HOSPITAL DISTRICT
Doing business as
CORA E BRAYNON FAMILY HLTH CTR
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 2021
Last certification
Jul 1, 2021
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Jan 6, 2004 in FL
Enrollment address
200 NW 7TH Ave
Fort Lauderdale, FL 33311-9026

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
NBHD Imperial Point Med140 organizations share this tax ID, including this one
Part of
NBHD Imperial Point Med

Organizations with this tax ID in the same state 24

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

View all 24

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Stuart M Glassberg Individual Corporate OfficerReimbursement Manager Jun 28, 2010
Nancy Gregoire Individual Corporate OfficerBoard Member Dec 1, 2017
Stacy Angier Individual Corporate OfficerBoard Member Oct 19, 2018
Ray Berry Individual Corporate OfficerBoard Member May 11, 2018
Marie Waugh Individual Corporate OfficerBoard Member Nov 30, 2018
Levi Williams Individual Corporate OfficerBoard Member Apr 2, 2021
Alexander Fernandez Individual Corporate OfficerCfo Dec 23, 2018
Corporate DirectorCfo Dec 13, 2018
Operational/Managerial ControlCfo Dec 23, 2018
Shane Strum Individual Corporate OfficerCeo Mar 29, 2021
Corporate DirectorCeo Mar 29, 2021
Operational/Managerial ControlCeo Mar 29, 2021
Christopher Pernicano Individual Corporate OfficerBoard Member Apr 2, 2021
Jonathan Hage Individual Corporate OfficerBoard Member Apr 2, 2021

NPI Registry JSON

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1184899452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 932540",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311932540",
            "telephone_number": "954-847-4315",
            "fax_number": "954-847-4270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S ANDREWS AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162510",
            "telephone_number": "954-847-4315",
            "fax_number": "954-847-4270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BROWARD HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH BROWARD HOSPITAL DISTRICT",
        "enumeration_date": "2008-04-28",
        "last_updated": "2024-05-10",
        "certification_date": "2023-02-14",
        "status": "A",
        "authorized_official_last_name": "BERT",
        "authorized_official_first_name": "ALISA",
        "authorized_official_title_or_position": "INTERIM CFO",
        "authorized_official_telephone_number": "954-847-4117"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "FL",
            "license": "4128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broward General Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Broward General Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.