NPIMap

Organization Active NPI

South Broward Hospital District

Doing business as Memorial Division of Pediatric Cardiac Surgery

  • Pediatric Surgery Physician
  • Hollywood, FL
National Provider Identifier
1376550392
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
Legal business name
SOUTH BROWARD HOSPITAL DISTRICT
Doing business as
Memorial Division of Pediatric Cardiac Surgery
Practice address
1150 N 35TH Ave Ste 490
Hollywood, FL 33021-5423
Phone
(954) 265-3437
Fax
(954) 265-3731
NPI assigned
Aug 2, 2006
Last updated
Aug 31, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH BROWARD HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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

Authorized official

Name
Esther Surujon
Title
Cfo, Memorial Physician Group & SBC
Phone
(954) 265-6677

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0120X Primary

Addresses

Primary practice location

1150 N 35TH Ave Ste 490
Hollywood, FL 33021-5423

Mailing address

2900 Corporate Way
Door D
Miramar, FL 33025-3925
Phone (954) 276-5685

Other practice location 1

3501 Johnson St Fl 1
Hollywood, FL 33021-5421
Phone (954) 265-3437

Other practice location 2

3377 S State Rd 7
Suite 100
Wellington, FL 33449
Phone (954) 265-3437

Other practice location 3

1971 SW 172nd Ave Ste 490
Miramar, FL 33029-5592
Phone (954) 265-3437

Other names 1

  • Memorial Division of Pediatric Cardiac Surgery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040107000217 FL Part B Supplier - Clinic/Group Practice 8123927373 Receives reassigned benefits from 490 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pembroke Pines, FL; Miramar, FL; Hollywood, FL; Wellington, FL; Weston, FL; Aventura, FL; Boca Raton, FL; Coral Springs, FL…
O20040209000093 FL Part B Supplier - Clinic/Group Practice 8123927373 Receives reassigned benefits from 80 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miramar, FL; Weston, FL; Wellington, FL; Hollywood, FL; Aventura, FL; Coral Springs, FL; Boca Raton, FL

Other NPIs on the same Medicare enrollment 19

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

View all 19

National Provider Directory

National Provider Directory
Part of
Eddy H Carrillo MD

Locations

5830 Coral Ridge Dr
Ste 207
Coral Springs, FL 33076
Phone (954) 501-0505

1005 N 35th Ave
Hollywood, FL 33021
Phone (954) 265-5324

1150 N 35th Ave
Ste 575
Hollywood, FL 33021
Phone (954) 265-3015

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693440000000",
    "number": "1376550392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N 35TH AVE STE 490",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215423",
            "telephone_number": "954-265-3437",
            "fax_number": "954-265-3731"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3501 Johnson St Fl 1",
            "address_purpose": "LOCATION",
            "city": "Hollywood",
            "state": "FL",
            "postal_code": "330215421",
            "country_code": "US",
            "telephone_number": "954-265-3437",
            "fax_number": "954-265-3731",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3377 S State Rd 7",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Wellington",
            "state": "FL",
            "postal_code": "33449",
            "country_code": "US",
            "telephone_number": "954-265-3437",
            "fax_number": "954-265-3731",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1971 SW 172nd Ave Ste 490",
            "address_purpose": "LOCATION",
            "city": "Miramar",
            "state": "FL",
            "postal_code": "330295592",
            "country_code": "US",
            "telephone_number": "954-265-3437",
            "fax_number": "954-276-3731",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "enumeration_date": "2006-08-02",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A",
        "authorized_official_last_name": "SURUJON",
        "authorized_official_first_name": "ESTHER",
        "authorized_official_title_or_position": "CFO, MEMORIAL PHYSICIAN GROUP & SBC",
        "authorized_official_telephone_number": "954-265-6677"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Pediatric Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Division of Pediatric Cardiac Surgery",
            "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 Aug 31, 2023; 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.