NPIMap

Organization Active NPI

Community Health of South Florida, Inc.

  • Federally Qualified Health Center (FQHC)
  • Miami, FL
National Provider Identifier
1295078186
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH OF SOUTH FLORIDA, INC.
Practice address
13540 SW 135TH Ave
Miami, FL 33186-6184
Phone
(305) 253-5100
Fax
(305) 252-5881
NPI assigned
Mar 29, 2013
Last updated
Aug 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Authorized official

Name
Blake Hall
Title
President/Ceo
Phone
(305) 253-5100

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Community/Behavioral Health Agency 251S00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Non-Pharmacy Dispensing Site 332900000X

Addresses

Primary practice location

13540 SW 135TH Ave
Miami, FL 33186-6184

Mailing address

10300 SW 216TH Street
Miami, FL 33190-1003
Phone (305) 253-5100

Other names 1

  • West Kendall Health Center Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118000460 FL Part B Supplier - Clinic/Group Practice 6507770526 Receives reassigned benefits from 147 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tavernier, FL; Cutler Bay, FL; South Miami, FL; Perrine, FL; Naranja, FL; Miami, FL; Marathon, FL; Key West, FL…
O20160510000295 FL Part A Provider - Federally Qualified Health Center (FQHC) 6507770526 Practice locations: Miami, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295078186. Details of each certification follow.

Federally qualified health center certification: CCN 681060

Legal name
COMMUNITY HEALTH OF SOUTH FLORIDA INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 10, 2016
Last certification
May 10, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
13540 SW 135TH Ave
Miami, FL 33186-6184

Other NPIs with the same Medicare PAC ID 17

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

View all 17

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
Tax ID family
Community Health Inc57 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

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
Linda Carmona-Sanchez Individual Corporate OfficerBoard of Director Jan 15, 2026
Natalie Windsor Individual Corporate DirectorBoard of Directors Jan 1, 2020
Ronald Eugene Coursey II Individual Corporate OfficerBoard of Director Jan 15, 2026
Paul Herdsman Individual Corporate DirectorBoard of Directors Jan 1, 2019
Jeremy Radziewicz Individual Corporate DirectorCfo Aug 6, 2018
W-2 Managing EmployeeCfo Aug 6, 2018
Ingrid Mapelli- Franco Individual Corporate OfficerBoard of Director Jan 15, 2026
Andre Reid Individual Corporate DirectorBoard of Directors Jan 1, 2020
Carolyn Taylor-Pates Individual Corporate DirectorBoard of Directors Jan 1, 2019
Arjun Saluja Individual Corporate OfficerBoard of Director Jan 15, 2026
Glen Smith Individual Corporate OfficerBoard of Director Jan 15, 2026
Carlo Saint Cy Individual Corporate DirectorBoard of Directors Jan 1, 2020
Claudia Guadalupe Gonzalez Individual Corporate OfficerBoard of Director Jan 15, 2026
Anthony B Hall Individual Corporate DirectorPresident/Ceo Jan 1, 2022
W-2 Managing EmployeePresient/Ceo Jan 1, 2022
Enrique Flores Individual Corporate OfficerBoard of Director Jan 15, 2026

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1364515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724889600000",
    "number": "1295078186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10300 SW 216TH STREET",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331901003",
            "telephone_number": "305-253-5100",
            "fax_number": "305-252-5881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13540 SW 135TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331866184",
            "telephone_number": "305-253-5100",
            "fax_number": "305-252-5881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH OF SOUTH FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-29",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "305-253-5100"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Kendall Health Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "West Kendall Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.