NPIMap

Organization Active NPI

North Broward Hospital District

Doing business as Bernard P. Alicki Health Center

  • Federally Qualified Health Center (FQHC)
  • Fort Lauderdale, FL
National Provider Identifier
1225073034
Registry record updated Mar 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTH BROWARD HOSPITAL DISTRICT
Doing business as
Bernard P. Alicki Health Center
Practice address
1101 W Broward Blvd
Fort Lauderdale, FL 33312
Phone
(954) 527-6025
NPI assigned
Jun 17, 2006
Last updated
Mar 29, 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 Mar 29, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

1101 W Broward Blvd
Fort Lauderdale, FL 33312

Mailing address

1700 NW 49TH St Ste 125
Fort Lauderdale, FL 33309-3750
Phone (954) 527-6041

Other identifiers 2

IdentifierTypeStateIssuer
253794022MedicaidFL
00020OtherFLBCBS

Other names 1

  • Bernard P. Alicki Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040405001860 FL Part B Supplier - Clinic/Group Practice 3577472422 Receives reassigned benefits from 251 practitioners
This NPI is an additional NPI on the enrollment
O20210721003394 FL Part A Provider - Federally Qualified Health Center (FQHC) 3577472422 Practice locations: Fort Lauderdale, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225073034. Details of each certification follow.

Federally qualified health center certification: CCN 681899

Legal name
NORTH BROWARD HOSPITAL DISTRICT
Doing business as
BERNARD P. ALICKI HEALTH CENTER
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
1101 W Broward Blvd
Fort Lauderdale, FL 33312-1638

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
N Btroward Hospital Dis140 organizations share this tax ID, including this one
Part of
N Btroward Hospital Dis

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

Locations

1101 W Broward Blvd
Ft Lauderdale, FL 33312
Phone (954) 527-6025

Networks

  • HealthSun Health Plans Network

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 23, 2018
Operational/Managerial ControlCfo Dec 23, 2018
Shane Strum Individual Corporate OfficerCeo Mar 29, 2021
Corporate DirectorCeo Mar 29, 2021
Operational/Managerial Control Mar 29, 2021
Christopher Pernicano Individual Corporate OfficerBoard Member Apr 2, 2021
Jonathan Hage Individual Corporate OfficerBoard Member Apr 2, 2021

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
Broward Health NorthDeerfield Beach, FL, CCN 100086 Hospital Operational/Managerial Control May 14, 2008
Broward Health Imperial PointFort Lauderdale, FL, CCN 100200 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1984
Jan 1, 1984
Broward Health Medical Center-Psych UnitFort Lauderdale, FL, CCN 10S039 Hospital Operational/Managerial Control Jul 1, 2007
Broward Health Coral SpringsCoral Springs, FL, CCN 100276 Hospital Operational/Managerial Control (100%) Mar 17, 1987
Broward Health Imperial Point-Psych UnitFort Lauderdale, FL, CCN 10S200 Hospital Operational/Managerial Control (100%) Jul 1, 1984
Broward Health North- Rehab UnitDeerfield Beach, FL, CCN 10T086 Hospital Operational/Managerial Control May 13, 2008
Pompano Adult Primary CarePompano Beach, FL, CCN 101840 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 1993
Oct 1, 1993
Specialty Care CenterFort Lauderdale, FL, CCN 101841 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 1993
Jul 1, 1993
Margate Health CenterMargate, FL, CCN 681892 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 1993
Oct 1, 1993

Owned or controlled facilities with NPI records 11

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711670400000",
    "number": "1225073034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 NW 49TH ST STE 125",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333093750",
            "telephone_number": "954-527-6041",
            "fax_number": "954-527-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 W BROWARD BLVD",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "33312",
            "telephone_number": "954-527-6025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BROWARD HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH BROWARD HOSPITAL DISTRICT",
        "enumeration_date": "2006-06-17",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-29",
        "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": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253794022",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00020",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bernard P. Alicki Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.