NPIMap

Organization Active NPI

Citrus Health Network Inc

  • Federally Qualified Health Center (FQHC)
  • Hialeah, FL
National Provider Identifier
1275647752
Registry record updated Nov 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
744441 Issued in FL
Legal business name
CITRUS HEALTH NETWORK INC
Practice address
4175 W 20TH Ave
Hialeah, FL 33012-5874
Phone
(305) 558-0151
Fax
(305) 818-1885
NPI assigned
Aug 19, 2006
Last updated
Nov 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2014

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

Authorized official

Name
Mr. Mario JardonNPI 1407909732
Title
Ceo
Phone
(305) 558-0151

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 744441 FL Primary

Addresses

Primary practice location

4175 W 20TH Ave
Hialeah, FL 33012-5874

Mailing address

4175 W 20TH Ave
Hialeah, FL 33012-5874
Phone (305) 558-0151

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040923000283 FL Part B Supplier - Clinic/Group Practice 9931177334 Receives reassigned benefits from 117 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hialeah, FL; Miami, FL
O20100923000626 FL Part A Provider - Federally Qualified Health Center (FQHC) 9931177334 Practice locations: Hialeah, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275647752. Details of each certification follow.

Federally qualified health center certification: CCN 101970

Legal name
CITRUS HEALTH NETWORK, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 13, 2005
Last certification
May 13, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 2, 1978 in FL
Enrollment address
4175W 20TH Ave
Hialeah, FL 33012-5874

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Citrus Health Network Inc26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Locations

1301 S Main St
Belle Glade, FL 33430
Phone (561) 992-4357

4175 W 20th Ave
Hialeah, FL 33012
Phone (305) 424-3030

551 W 51st Pl
Fl 2
Hialeah, FL 33012
Phone (305) 817-6560

7150 W 20th Ave
Ste 201
Hialeah, FL 33016
Phone (305) 362-0606

802 S Dixie Hwy
Lake Worth, FL 33460

1645 SW 107th Ave
#A
Miami, FL 33165
Phone (305) 424-3100

8765 SW 165th Ave
Ste 114
Miami, FL 33193

Networks

  • HealthSun Health Plans Network

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Gil Lopez Individual Corporate DirectorBoard Member Oct 1, 2005
Caridad Castro Individual Corporate DirectorBoard Member Oct 1, 1993
Alicia Arner Individual Corporate DirectorBoard Member Sep 27, 2016
Sanford Bohrer Individual Corporate DirectorBoard Member May 28, 2019
Mario Jardon Individual Corporate OfficerPresident and Ceo Sep 1, 1979
W-2 Managing EmployeePresident and Ceo Oct 1, 1980
Tyrone Coverson Individual Corporate DirectorBoard Member Oct 1, 1999
Maria Alonso Individual Corporate OfficerCoo Mar 16, 1981
W-2 Managing EmployeeCoo Jul 21, 2010
Jose Delcueto Individual Corporate DirectorBoard Member Oct 22, 2019
Karin F Esposito Individual Corporate DirectorBoard Member May 28, 2019
Pauline Clark-Trotman Individual Corporate DirectorBoard Member Apr 27, 2018
Georgina Cortes Suarez Individual Corporate DirectorBoard Member Oct 1, 2006
Patricia Croysdale Individual Corporate DirectorBoard Member Oct 1, 1995
Fernando Franco Individual Corporate DirectorBoard Member Jun 17, 2014
Maria Teresa Sanjuan Individual Corporate DirectorBoard Member Oct 1, 2003

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414972800000",
    "number": "1275647752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4175 W 20TH AVE",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330125874",
            "telephone_number": "305-558-0151",
            "fax_number": "305-818-1885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4175 W 20TH AVE",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330125874",
            "telephone_number": "305-558-0151",
            "fax_number": "305-818-1885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITRUS HEALTH NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2014-11-03",
        "status": "A",
        "authorized_official_last_name": "JARDON",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-558-0151",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "FL",
            "license": "744441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

Verify at the official NPI Registry.