NPIMap

Organization Active NPI

Jessie Trice Community Health System Inc

Doing business as Jessie Trice Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Miami, FL
National Provider Identifier
1306452438
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JESSIE TRICE COMMUNITY HEALTH SYSTEM INC
Doing business as
Jessie Trice Community Health Center
Practice address
5361 NW 22ND Ave # M1
Miami, FL 33142-8035
Phone
(305) 637-6400
Fax
(305) 636-5155
NPI assigned
Sep 23, 2020
Last updated
Nov 26, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
JESSIE TRICE COMMUNITY HEALTH SYSTEM, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Authorized official

Name
Ryan R Hawkins
Title
President/Ceo
Phone
(305) 805-1700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

5361 NW 22ND Ave # M1
Miami, FL 33142-8035

Mailing address

5607 NW 27TH Ave Ste 1
Miami, FL 33142-2826
Phone (305) 805-1700

Other names 1

  • Jessie Trice Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041020000714 FL Part B Supplier - Clinic/Group Practice 2961486733 Receives reassigned benefits from 59 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL; Opa Locka, FL; Miami Gardens, FL; Hialeah, FL

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Economic Opportunity FH15 organizations share this tax ID, including this one
Part of
Economic Opportunity FH

Other organizations with this tax ID 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 7

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": "1600819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1306452438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5607 NW 27TH AVE STE 1",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331422826",
            "telephone_number": "305-805-1700",
            "fax_number": "305-805-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5361 NW 22ND AVE # M1",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331428035",
            "telephone_number": "305-637-6400",
            "fax_number": "305-636-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSIE TRICE COMMUNITY HEALTH SYSTEM INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC",
        "enumeration_date": "2020-09-23",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "305-805-1700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jessie Trice Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jessie Trice Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 26, 2024; 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.