Blue Diamond Medical Center Corp.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

BLUE DIAMOND MEDICAL CENTER CORP.

Practice address

16430 NW 59TH Ave
Miami Lakes, FL 33014-5605

Phone

(305) 456-0148

NPI assigned

Aug 5, 2022

Last updated

Apr 15, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marcos Jose Carvajal, APRNNPI 1649537606

Title

Aprn-FNP

Phone

(305) 456-0148

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

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.

• Marcos Jose Carvajal, APRN

  • Family Nurse Practitioner
  • Miramar, FL
  • NPI 1649537606
  Medicare reassignment Authorized official
• Lellanys Pino

  • Family Nurse Practitioner
  • Hialeah, FL
  • NPI 1285454876
  NPD (past)

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

{
    "created_epoch": "1659657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681516800000",
    "number": "1245967587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16430 NW 59TH AVE STE 202",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330145605",
            "telephone_number": "305-456-0148",
            "fax_number": "305-456-7559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16430 NW 59TH AVE",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330145605",
            "telephone_number": "305-456-0148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE DIAMOND MEDICAL CENTER CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-05",
        "last_updated": "2023-04-15",
        "certification_date": "2023-04-15",
        "status": "A",
        "authorized_official_last_name": "CARVAJAL",
        "authorized_official_first_name": "MARCOS",
        "authorized_official_middle_name": "JOSE",
        "authorized_official_title_or_position": "APRN-FNP",
        "authorized_official_telephone_number": "305-456-0148",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "EMR",
            "affiliation": "N",
            "endpointDescription": "x",
            "use": "DIRECT",
            "useDescription": "Direct",
            "useOtherDescription": "x",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "x",
            "address_1": "16430 NW 59th Ave",
            "city": "Miami Lakes",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330145605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Nurse Practitioner in Miami Lakes, FL
• Providers in Miami Lakes, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.