NPIMap

Organization Active NPI

Energy Community Mental Health Clinic LLC

  • Family Medicine Physician
  • Miami, FL
National Provider Identifier
1295310514
Registry record updated Nov 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ENERGY COMMUNITY MENTAL HEALTH CLINIC LLC
Practice address
4995 NW 72ND Ave Ste 102
Miami, FL 33166-5643
Phone
(786) 227-2966
NPI assigned
Mar 17, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2023

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

Authorized official

Name
Ernesto Rodriguez Tanquero
Title
President
Phone
(786) 227-2966

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Case Management Agency 251B00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

4995 NW 72ND Ave Ste 102
Miami, FL 33166-5643

Mailing address

4995 NW 72ND Ave Ste 102
Miami, FL 33166-5643
Phone (786) 227-2966

Other practice location 1

2337 W 76th St
Hialeah, FL 33016-1842
Phone (786) 360-3584

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211027001427 FL Part B Supplier - Clinic/Group Practice 9931597788 Receives reassigned benefits from 3 practitioners
Practice locations: Hialeah, FL; Miami, FL

National Provider Directory

National Provider Directory
Tax ID family
Energy Community Mental Health Clinic LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

4995 NW 72nd Ave
Ste 102
Miami, FL 33166
Phone (786) 227-2966

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700524800000",
    "number": "1295310514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4995 NW 72ND AVE STE 102",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331665643",
            "telephone_number": "786-227-2966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4995 NW 72ND AVE STE 102",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331665643",
            "telephone_number": "786-227-2966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2337 W 76th St",
            "address_purpose": "LOCATION",
            "city": "Hialeah",
            "state": "FL",
            "postal_code": "330161842",
            "country_code": "US",
            "telephone_number": "786-360-3584",
            "fax_number": "786-360-3867",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ENERGY COMMUNITY MENTAL HEALTH CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-17",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ TANQUERO",
        "authorized_official_first_name": "ERNESTO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "786-227-2966"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; 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.