NPIMap

Organization Active NPI

Variety Children'S Hospital

  • Pediatric Gastroenterology Physician
  • Loxahatchee, FL
National Provider Identifier
1235455023
Registry record updated Oct 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
Legal business name
VARIETY CHILDREN'S HOSPITAL
Practice address
12989 Southern Blvd
Palms West Mob III Suite 203
Loxahatchee, FL 33470-9211
Phone
(561) 383-7113
NPI assigned
Apr 19, 2010
Organization subpart
Yes
Parent organization
MIAMI CHILDREN'S HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 29, 2014

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

Authorized official

Name
Timothy Birkenstock
Title
Senior VP & Cfo
Phone
(305) 669-6422

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XP3100X
Pediatric Endocrinology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0205X
Pediatric Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0206X Primary
Plastic and Reconstructive Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0122X

Addresses

Primary practice location

12989 Southern Blvd
Palms West Mob III Suite 203
Loxahatchee, FL 33470-9211

Mailing address

PO Box 863941
Orlando, FL 32886-3941
Phone (305) 662-8334

Other identifiers 1

IdentifierTypeStateIssuer
255772027MedicaidFL

Other names 1

  • MCH Specialist Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Variety Childrens Hospital18 organizations share this tax ID, including this one
Part of
Variety Childrens Hospital

Other organizations with this tax ID 17

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

View all 17

Locations

12989 Southern Blvd
Ste 203
Loxahatchee, FL 33470
Phone (561) 383-7113

NPI Registry JSON

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

{
    "created_epoch": "1271635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414540800000",
    "number": "1235455023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 863941",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328863941",
            "telephone_number": "305-662-8334",
            "fax_number": "786-624-2688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12989 SOUTHERN BLVD",
            "address_2": "PALMS WEST MOB III SUITE 203",
            "city": "LOXAHATCHEE",
            "state": "FL",
            "postal_code": "334709211",
            "telephone_number": "561-383-7113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VARIETY CHILDREN'S HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIAMI CHILDREN'S HOSPITAL",
        "enumeration_date": "2010-04-19",
        "last_updated": "2014-10-29",
        "status": "A",
        "authorized_official_last_name": "BIRKENSTOCK",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "SENIOR VP & CFO",
        "authorized_official_telephone_number": "305-669-6422"
    },
    "taxonomies": [
        {
            "code": "207XP3100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255772027",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MCH Specialist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loxahatchee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.