Individual provider Active NPI

Neeraj Kumar Raghunath, MD

  • Pediatric Gastroenterology Physician
  • Hollywood, FL
National Provider Identifier
1275855595
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
ME106643 Issued in FL
Practice address
1150 N 35TH Ave
Suite 545
Hollywood, FL 33021-5424
Phone
(954) 967-9400
NPI assigned
Mar 1, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X 247500 NY
Pediatric Gastroenterology Physician 2080P0206X ME106643 FL Primary

Addresses

Primary practice location

1150 N 35TH Ave
Suite 545
Hollywood, FL 33021-5424

Mailing address

5955 Ponce de Leon Blvd.
Coral Gables, FL 33146
Phone (305) 661-1515

Other practice location 1

7100 W 20th Ave Ste 616
Hialeah, FL 33016-1814
Phone (305) 556-4263

Other identifiers 1

IdentifierTypeStateIssuer
002484900MedicaidFL

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110927000792 FL Practitioner - Pediatric MedicinePractitioner - Gastroenterology 4284805045 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Gastroenterology
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kidz Medical Services IncGroup PAC ID 3678536240, 24 clinicians

Practice addresses (Care Compare)

975 Baptist Way
Homestead, FL 33033-7600
Phone 3056611515243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME106643FLMDPediatric Gastroenterology Physician
247500NYMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kidz Medical Services, Inc Pediatric Gastroenterology CurrentSince Jul 8, 2014 Accepting new patients
Kidz Medical Services, Inc CurrentSince Jul 8, 2014 Accepting new patients
Kidz Medical Services, Inc. Pediatric Gastroenterology PastSince Sep 1, 2021 Accepting new patients

Locations

9980 Central Park Blvd N
Ste 318
Boca Raton, FL 33428
Phone (561) 451-0500

5955 Ponce de Leon Blvd
Coral Gables, FL 33146
Phone (305) 662-8668

7100 W 20th Ave
Ste 616
Hialeah, FL 33016
Phone (305) 435-4465

1150 N 35th Ave
Ste 545
Hollywood, FL 33021
Phone (954) 966-6225

3800 Johnson St
Ste J
Hollywood, FL 33021
Phone (954) 967-9400

975 Baptist Way
Ste 203
Homestead, FL 33033
Phone (305) 242-8200

Interoperability endpoints

  • Direct secure messaging: neerajraghunath@kms.allscriptsdirect.net

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1267401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1275855595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5955 PONCE DE LEON BLVD.",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "33146",
            "telephone_number": "305-661-1515",
            "fax_number": "305-662-3723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N 35TH AVE",
            "address_2": "SUITE 545",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215424",
            "telephone_number": "954-967-9400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7100 W 20th Ave Ste 616",
            "address_purpose": "LOCATION",
            "city": "Hialeah",
            "state": "FL",
            "postal_code": "330161814",
            "country_code": "US",
            "telephone_number": "305-556-4263",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAGHUNATH",
        "first_name": "NEERAJ",
        "middle_name": "KUMAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-01",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NY",
            "license": "247500",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "FL",
            "license": "ME106643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002484900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.