NPIMap

Organization Active NPI

Conviva Specialty, LLC

  • Cardiovascular Disease Physician
  • Miami, FL
National Provider Identifier
1326498676
Registry record updated Oct 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CONVIVA SPECIALTY, LLC
Practice address
12905 SW 42ND St Ste 103
Miami, FL 33175-2910
Phone
(786) 801-5620
NPI assigned
Jun 17, 2016
Last updated
Oct 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2025

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

Authorized official

Name
Dr. Jessica Bonetti
Title
Associate Director
Phone
(305) 500-2000

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X Primary
Gastroenterology Physician 207RG0100X
Neurological Surgery Physician 207T00000X
Obstetrics & Gynecology Physician 207V00000X ME116882 FL
Physical Medicine & Rehabilitation Physician 208100000X ME129977 FL

Addresses

Primary practice location

12905 SW 42ND St Ste 103
Miami, FL 33175-2910

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000

Other identifiers 1

IdentifierTypeStateIssuer
021709600MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170501001372 FL Part B Supplier - Clinic/Group Practice 2365729308 Receives reassigned benefits from 44 practitioners
Practice locations: Pembroke Pines, FL; Jupiter, FL; Kissimmee, FL; Lake Park, FL; Lantana, FL; Miami, FL; Miami Beach, FL; North Miami, FL…

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4828 Coconut Creek Pkwy
Coconut Creek, FL 33063
Phone (954) 247-2168

137 S Compass Way
Dania Beach, FL 33004
Phone (954) 962-9811

5799 Lake Worth Rd
Greenacres, FL 33463
Phone (561) 967-0234

7031 Washington Ave
Lantana, FL 33462
Phone (561) 585-2550

11200 W Flagler St
Ste 101TO107
Miami, FL 33174

301 NW 84th Ave
#302
Plantation, FL 33324
Phone (954) 247-2168

4340 W Hillsborough Ave
Ste 210
Tampa, FL 33614
Phone (813) 425-8970

Practitioners & affiliated clinicians

Practitioners 63

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.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1466121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761696000000",
    "number": "1326498676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12905 SW 42ND ST STE 103",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331752910",
            "telephone_number": "786-801-5620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVIVA SPECIALTY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-17",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A",
        "authorized_official_last_name": "BONETTI",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "305-500-2000",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME116882",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "FL",
            "license": "ME129977",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021709600",
            "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 Oct 29, 2025; 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.