NPIMap

Organization Active NPI

Palm Medical Center Plantation, LLC

  • Clinic/Center
  • Plantation, FL
National Provider Identifier
1417458464
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PALM MEDICAL CENTER PLANTATION, LLC
Practice address
6971 W Sunrise Blvd Ste 105-106
Plantation, FL 33313-4407
Phone
(954) 583-3500
NPI assigned
Feb 26, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Mr. Juan M Ortiz
Title
Ceo
Phone
(305) 913-9444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

6971 W Sunrise Blvd Ste 105-106
Plantation, FL 33313-4407

Mailing address

2600 S Douglas Rd Ste 308
Coral Gables, FL 33134-6134
Phone (305) 913-9444

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160818001144 FL Part B Supplier - Clinic/Group Practice 8224323050 Receives reassigned benefits from 72 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Land O Lakes, FL; Plantation, FL; Port Richey, FL; Sebring, FL; Plant City, FL; Spring Hill, FL; Tamarac, FL; Tampa, FL…

Other NPIs on the same Medicare enrollment 7

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0858610Palm Medical Center Plantation LLC6971 W Sunrise Blvd Ste 106, Plantation, FL 33313Certificate of waiverJan 14, 2028

National Provider Directory

National Provider Directory
Tax ID family
Palm Medical Centers23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Locations

6849 Taft St
Hollywood, FL 33024
Phone (954) 266-2920

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1519603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1417458464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 S DOUGLAS RD STE 308",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331346134",
            "telephone_number": "305-913-9444",
            "fax_number": "305-442-1198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6971 W SUNRISE BLVD STE 105-106",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333134407",
            "telephone_number": "954-583-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM MEDICAL CENTER PLANTATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-26",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "ORTIZ",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-913-9444",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plantation, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.