NPIMap

Organization Active NPI

Professional Medical Services & Management Inc.

  • Multi-Specialty Clinic/Center
  • Hialeah, FL
National Provider Identifier
1417233222
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PROFESSIONAL MEDICAL SERVICES & MANAGEMENT INC.
Practice address
315 W 9TH St FL 2
Hialeah, FL 33010-3853
Phone
(786) 360-4528
Fax
(786) 360-4529
NPI assigned
Oct 25, 2011
Last updated
Jan 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Authorized official

Name
Sandy Lopez
Title
President/ Ceo
Phone
(786) 360-4528

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X FL
Clinic/Center 261Q00000X
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

315 W 9TH St FL 2
Hialeah, FL 33010-3853

Mailing address

315 W 9TH St
Second Floor
Hialeah, FL 33010-3853
Phone (786) 360-4528

Other identifiers 2

IdentifierTypeStateIssuer
ME51845OtherFLMEDICAL LICENSE
000645500MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120711000194 FL Part B Supplier - Clinic/Group Practice 4082879309 Receives reassigned benefits from 4 practitioners
Practice locations: Hialeah, FL

National Provider Directory

National Provider Directory
Tax ID family
Professional Medical Services and Management Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

315 W 9th St
Fl Second
Hialeah, FL 33010

Practitioners & affiliated clinicians

Practitioners 5

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": "1319500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1417233222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 W 9TH ST",
            "address_2": "SECOND FLOOR",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330103853",
            "telephone_number": "786-360-4528",
            "fax_number": "786-360-4529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W 9TH ST FL 2",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330103853",
            "telephone_number": "786-360-4528",
            "fax_number": "786-360-4529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL MEDICAL SERVICES & MANAGEMENT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-25",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "SANDY",
        "authorized_official_title_or_position": "PRESIDENT/ CEO",
        "authorized_official_telephone_number": "786-360-4528"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME51845",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000645500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.