NPIMap

Organization Active NPI

St Jude Medical Group Corp

Doing business as Vidamax Medical Center

  • Clinic/Center
  • Hollywood, FL
National Provider Identifier
1356167365
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
Doing business as
Vidamax Medical Center
Practice address
6109 Pembroke Rd
Hollywood, FL 33023-2213
Phone
(954) 239-7054
Fax
(786) 464-5125
NPI assigned
Nov 25, 2024
Last updated
Nov 25, 2024By the provider in NPPES
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, MDNPI 1356584361
Title
Medical Director
Phone
(786) 464-5120

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

6109 Pembroke Rd
Hollywood, FL 33023-2213

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

6109 Pembroke Rd
Hollywood, FL 33023
Phone (954) 239-7054

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 1

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": "1732492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1356167365",
    "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": "6109 PEMBROKE RD",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330232213",
            "telephone_number": "954-239-7054",
            "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VIDAMAX MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollywood, 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.