Organization Active NPI

Sawgrass Hospitalist PA

  • Hospitalist Physician
  • Hollywood, FL
National Provider Identifier
1447595194
Registry record updated Dec 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
SAWGRASS HOSPITALIST PA
Practice address
3501 Johnson St
Hollywood, FL 33021-5421
Phone
(954) 987-2000
Fax
(954) 964-6084
NPI assigned
Dec 6, 2012
Last updated
Dec 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2012

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

Authorized official

Name
Rafael Segundo Briceno, M.D.NPI 1174670863
Title
President
Phone
(610) 331-0782

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X NU Primary

Addresses

Primary practice location

3501 Johnson St
Hollywood, FL 33021-5421

Mailing address

3093 NW 126TH Ave
Sunrise, FL 33323-6342
Phone (610) 331-0782

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130425000387 FL Part B Supplier - Clinic/Group Practice 3577709278 Receives reassigned benefits from 4 practitioners
Practice locations: Pembroke Pines, FL; Hollywood, FL

National Provider Directory

National Provider Directory

Locations

3363 Sheridan St
Ste 207
Hollywood, FL 33021
Phone (954) 962-9650

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": "1354752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1447595194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3093 NW 126TH AVE",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333236342",
            "telephone_number": "610-331-0782",
            "fax_number": "954-964-6084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 JOHNSON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215421",
            "telephone_number": "954-987-2000",
            "fax_number": "954-964-6084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAWGRASS HOSPITALIST PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-06",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "BRICENO",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_middle_name": "SEGUNDO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "610-331-0782",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Dec 6, 2012; 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.