NPIMap

Organization Active NPI

Childrens Diagnostic & Treatment Center Inc

  • Pediatrics Physician
  • Fort Lauderdale, FL
National Provider Identifier
1437733425
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CHILDRENS DIAGNOSTIC & TREATMENT CENTER INC
Practice address
5201 NW 33Rd Ave
Fort Lauderdale, FL 33309-6302
Phone
(954) 728-8080
Fax
(954) 779-1957
NPI assigned
May 6, 2021
Last updated
Sep 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Authorized official

Name
Ana Calderon Randazzo, PHD
Title
Administrator
Phone
(954) 728-1060

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Family Medicine Physician 207Q00000X NU
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

5201 NW 33Rd Ave
Fort Lauderdale, FL 33309-6302

Mailing address

1700 NW 49TH St Ste 125
Fort Lauderdale, FL 33309-3750
Phone (954) 728-8080

Other practice location 1

600 S Pine Island Rd Ste 204
Plantation, FL 33324-3179
Phone (954) 888-3900

Other practice location 2

1401 S Federal Hwy
Fort Lauderdale, FL 33316-2619
Phone (954) 728-8080

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040211000294 FL Part B Supplier - Clinic/Group Practice 4880588896 Receives reassigned benefits from 11 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Lauderdale, FL; Ft Lauderdale, FL

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Childrens Diagnostic Treatment Center Inc6 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

5201 NW 33rd Ave
Fort Lauderdale, FL 33309
Phone (954) 728-8080

Practitioners & affiliated clinicians

Practitioners 2

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": "1620259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1437733425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 NW 49TH ST STE 125",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333093750",
            "telephone_number": "954-728-8080",
            "fax_number": "954-779-1957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 NW 33RD AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333096302",
            "telephone_number": "954-728-8080",
            "fax_number": "954-779-1957"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 S Pine Island Rd Ste 204",
            "address_purpose": "LOCATION",
            "city": "Plantation",
            "state": "FL",
            "postal_code": "333243179",
            "country_code": "US",
            "telephone_number": "954-888-3900",
            "fax_number": "954-888-3938",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 S Federal Hwy",
            "address_purpose": "LOCATION",
            "city": "Fort Lauderdale",
            "state": "FL",
            "postal_code": "333162619",
            "country_code": "US",
            "telephone_number": "954-728-8080",
            "fax_number": "954-779-1957",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHILDRENS DIAGNOSTIC & TREATMENT CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-06",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "CALDERON RANDAZZO",
        "authorized_official_first_name": "ANA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "954-728-1060",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; 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.