Jimmy David Heredia, APN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9235081 Issued in FL

Practice address

1611 NW 12TH Ave
Miami, FL 33136-1005

Phone

(305) 585-1111

NPI assigned

Dec 3, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Powerback Rehabilitation LLCGroup PAC ID 2365359932, shared by 106 NPIs, 600 clinicians

Public Health Trust of Miami Dade County FloridaGroup PAC ID 1759432362, 132 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Public Health Trust of Miami Dade County Florida

  • Emergency Medicine Physician
  • Miami, FL
  • NPI 1235378001
  Medicare reassignment Care Compare group NPD
• Public Health Trust of Miami Dade County Florida

  • General Acute Care Hospital
  • Miami, FL
  • NPI 1225033020
  Medicare reassignment NPD
• Public Health Trust of Miami Dade County Florida

  • Urgent Care Clinic/Center
  • Doral, FL
  • NPI 1356883011
  NPD
• Public Health Trust of Miami Dade County Florida

  • Urgent Care Clinic/Center
  • Miami Beach, FL
  • NPI 1578418232
  NPD
• Public Health Trust of Miami Dade County Florida

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Opa-Locka, FL
  • NPI 1063417483
  NPD (past)

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

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543795200000",
    "number": "1255801296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13532 SW 102ND LN",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331862820",
            "telephone_number": "305-951-0375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 NW 12TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331361005",
            "telephone_number": "305-585-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEREDIA",
        "first_name": "JIMMY",
        "middle_name": "DAVID",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-03",
        "last_updated": "2018-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9235081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Heredia Gonzalez
• Omar Alfonso Heredia Nieto, MD
• Wilson Domingo Heredia Nunez, M.D.
• Dianisvey C Heredia Pais
• Isabel Heredia, APRN
• Mercedes Heredia
• Miguel A Heredia
• Yenisleidy Hereira
• Rajeev Herekar, DO
• Ana Heretoiu

• Family Nurse Practitioner in Miami, FL
• Providers in Miami, 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 Dec 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.