NPIMap

Organization Active NPI

Pediatric Gastroenterology Associates PLLC

  • Pediatric Gastroenterology Physician
  • Miami, FL
National Provider Identifier
1295766558
Registry record updated Dec 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
Legal business name
PEDIATRIC GASTROENTEROLOGY ASSOCIATES PLLC
Practice address
8955 SW 87TH CT Ste 206
Miami, FL 33176-2223
Phone
(786) 888-2480
NPI assigned
Jul 5, 2006
Last updated
Dec 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2020

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

Authorized official

Name
Dr. Jesse Reeves-Garcia, MDNPI 1134150477
Title
President
Phone
(305) 661-6110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0206X Primary

Addresses

Primary practice location

8955 SW 87TH CT Ste 206
Miami, FL 33176-2223

Mailing address

3200 SW 60TH CT Ste 204
Miami, FL 33155-4070
Phone (305) 661-6110

Other practice location 1

3200 SW 60th Ct Ste 204
Miami, FL 33155-4070
Phone (305) 661-6110

Other identifiers 1

IdentifierTypeStateIssuer
377245400MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110418000594 FL Part B Supplier - Clinic/Group Practice 6305020256 Receives reassigned benefits from 8 practitioners
Practice locations: Miami, FL

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Gastroenterology Associates2 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

8955 SW 87th Ct
Ste 206
Miami, FL 33176
Phone (305) 596-4440

Practitioners & affiliated clinicians

Practitioners 9

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": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607385600000",
    "number": "1295766558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 SW 60TH CT STE 204",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331554070",
            "telephone_number": "305-661-6110",
            "fax_number": "305-662-5882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8955 SW 87TH CT STE 206",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331762223",
            "telephone_number": "786-888-2480"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 SW 60th Ct Ste 204",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331554070",
            "country_code": "US",
            "telephone_number": "305-661-6110",
            "fax_number": "305-662-5882",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC GASTROENTEROLOGY ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A",
        "authorized_official_last_name": "REEVES-GARCIA",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-661-6110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "377245400",
            "state": "FL"
        }
    ],
    "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 Dec 8, 2020; 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.