NPIMap

Organization Active NPI

St Jude Medical Group Corp

  • Clinic/Center
  • Miami, FL
National Provider Identifier
1336965342
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ST JUDE MEDICAL GROUP CORP
Practice address
10522 SW 8TH St
Miami, FL 33174-2602
Phone
(786) 464-5120
Fax
(786) 464-5125
NPI assigned
Nov 25, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Authorized official

Name
Manuel D. Gonzalez, MD
Title
Medical Director
Phone
(786) 464-5120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

10522 SW 8TH St
Miami, FL 33174-2602

Mailing address

2141 NW 7TH St
Miami, FL 33125-3483
Phone (786) 464-5120

Other names 1

  • VIDAMAX MEDICAL CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Jude Medical Group Corp6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

10522 SW 8th St
Miami, FL 33174
Phone (786) 464-5120

Networks

  • HealthSun Health Plans Network

NPI Registry JSON

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

{
    "created_epoch": "1732492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1336965342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2141 NW 7TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331253483",
            "telephone_number": "786-464-5120",
            "fax_number": "786-464-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10522 SW 8TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331742602",
            "telephone_number": "786-464-5120",
            "fax_number": "786-464-5125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDE MEDICAL GROUP CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-25",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "786-464-5120",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VIDAMAX MEDICAL 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 25, 2024; 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.