Trident Medical Group PA

Primary specialty

Public Medicine PodiatristTaxonomy code 213EP0504X

Legal business name

TRIDENT MEDICAL GROUP PA

Practice address

382 NE 191St St
PMB 75481
Miami, FL 33179-3899

Phone

(855) 770-7771

NPI assigned

Sep 30, 2021

Organization subpart

No

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

Authorized official

Name

Devion Smith

Title

Director, Payer Contracting

Phone

(424) 326-8711

Specialties & licenses 7

Addresses

Locations

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

{
    "created_epoch": "1632960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668384000000",
    "number": "1295407922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1256 FOLSOM ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941033817",
            "telephone_number": "310-626-0149",
            "fax_number": "855-836-2741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 NE 191ST ST",
            "address_2": "PMB 75481",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331793899",
            "telephone_number": "855-770-7771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIDENT MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-30",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DEVION",
        "authorized_official_title_or_position": "DIRECTOR, PAYER CONTRACTING",
        "authorized_official_telephone_number": "424-326-8711"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213EP0504X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Public Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.