NPIMap

Organization Active NPI

South Broward Hospital District

Doing business as Memorial Division of Professional Services

  • Surgical Physician Assistant
  • Hollywood, FL
National Provider Identifier
1285641209
Registry record updated Feb 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Legal business name
SOUTH BROWARD HOSPITAL DISTRICT
Doing business as
Memorial Division of Professional Services
Practice address
3501 Johnson Street
Hollywood, FL 33021
Phone
(954) 987-2000
Fax
(954) 985-5691
NPI assigned
Aug 2, 2006
Last updated
Feb 16, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2017

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

Authorized official

Name
Mario Salceda-Cruz
Title
Administrator
Phone
(954) 265-4684

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X Primary

Addresses

Primary practice location

3501 Johnson Street
Hollywood, FL 33021

Mailing address

2900 Corporate Way
Door D
Miramar, FL 33025-3925
Phone (954) 276-5685

Other names 1

  • Memorial Division of Professional Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040107000217 FL Part B Supplier - Clinic/Group Practice 8123927373 Receives reassigned benefits from 490 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pembroke Pines, FL; Miramar, FL; Hollywood, FL; Wellington, FL; Weston, FL; Aventura, FL; Boca Raton, FL; Coral Springs, FL…

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory

Locations

5830 Coral Ridge Dr
Ste 140
Coral Springs, FL 33076
Phone (954) 265-1616

140A S Federal Hwy
Dania Beach, FL 33004
Phone (954) 265-8100

1150 N 35th Ave
Ste 205A
Hollywood, FL 33021
Phone (954) 265-0000

1150 N 35th Ave
Ste 345
Hollywood, FL 33021
Phone (954) 986-6300

1150 N 35th Ave
Ste 600
Hollywood, FL 33021
Phone (954) 265-5969

3501 Johnson St
#3
Hollywood, FL 33021
Phone (864) 551-6820

4150 Pembroke Rd
Hollywood, FL 33021

12781 Miramar Pkwy
#1202
Miramar, FL 33027

1951 SW 172nd Ave
Ste 313
Miramar, FL 33029
Phone (954) 276-5603

1971 SW 172nd Ave
Fl 2
Miramar, FL 33029
Phone (954) 265-2234

2900 Corporate Way
Miramar, FL 33025
Phone (954) 276-5685

603 N Flamingo Rd
Pembroke Pines, FL 33028
Phone (954) 844-5000

603 N Flamingo Rd
Ste 260
Pembroke Pines, FL 33028
Phone (954) 265-7750

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487203200000",
    "number": "1285641209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 JOHNSON STREET",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "33021",
            "telephone_number": "954-987-2000",
            "fax_number": "954-985-5691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2017-02-16",
        "status": "A",
        "authorized_official_last_name": "SALCEDA-CRUZ",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "954-265-4684"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Division of Professional Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollywood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; 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.