NPIMap

Organization Active NPI

Nicklaus Children'S Hospital Palm Beach Gardens Outpatient Center

  • Children's Hospital
  • Palm Beach Gardens, FL
National Provider Identifier
1487927810
Registry record updated Mar 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's HospitalTaxonomy code 282NC2000X
Legal business name
NICKLAUS CHILDREN'S HOSPITAL PALM BEACH GARDENS OUTPATIENT CENTER
Doing business as
Nicklaus Children's Palm Beach Gardens Outpatient Center
Practice address
11310 Legacy Ave
Palm Beach Gardens, FL 33410-3658
Phone
(305) 666-6511
NPI assigned
Feb 15, 2012
Organization subpart
Yes
Parent organization
VARIETY CHILDREN'S HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 15, 2018

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

Authorized official

Name
Raiza Vidaurrazaga
Title
Manager, Provider Relations
Phone
(786) 525-5405

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X
Rehabilitation Clinic/Center 261QR0400X
Urgent Care Clinic/Center 261QU0200X
Children's Hospital 282NC2000X Primary

Addresses

Primary practice location

11310 Legacy Ave
Palm Beach Gardens, FL 33410-3658

Mailing address

PO Box 557367
Miami, FL 33255-7367
Phone (786) 624-5876

Other identifiers 1

IdentifierTypeStateIssuer
010060930MedicaidFL

Other names 1

  • Nicklaus Children's Palm Beach Gardens Outpatient Center Doing business as

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
10D2040351Nicklaus Children'S Palm Beach Gardens Outpatient11310 Legacy Blvd, Palm Beach Gardens, FL 33410AccreditationApr 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Barbara and Jack Kay Early Childhood Learning Center5 organizations share this tax ID, including this one
Part of
Miami Children'S Hosptial

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521072000000",
    "number": "1487927810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 557367",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "332557367",
            "telephone_number": "786-624-5876",
            "fax_number": "786-624-2688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11310 LEGACY AVE",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334103658",
            "telephone_number": "305-666-6511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICKLAUS CHILDREN'S HOSPITAL PALM BEACH GARDENS OUTPATIENT CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VARIETY CHILDREN'S HOSPITAL",
        "enumeration_date": "2012-02-15",
        "last_updated": "2018-03-15",
        "status": "A",
        "authorized_official_last_name": "VIDAURRAZAGA",
        "authorized_official_first_name": "RAIZA",
        "authorized_official_title_or_position": "MANAGER, PROVIDER RELATIONS",
        "authorized_official_telephone_number": "786-525-5405"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC2000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010060930",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nicklaus Children's Palm Beach Gardens Outpatient Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nicklaus Children's Palm Beach Gardens Outpatient Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palm Beach Gardens, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.