NPIMap

Organization Active NPI

CCG of South Florida LLC

  • Internal Medicine Physician
  • Coral Springs, FL
National Provider Identifier
1497034086
Registry record updated Aug 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CCG OF SOUTH FLORIDA LLC
Practice address
2901 Coral Hills Dr
Suite 360
Coral Springs, FL 33065-4146
Phone
(954) 255-7310
Fax
(954) 255-7311
NPI assigned
Aug 12, 2011
Last updated
Aug 12, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2011

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

Authorized official

Name
Mario B Pereira, MDNPI 1760680466
Title
President
Phone
(954) 255-7310

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
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2901 Coral Hills Dr
Suite 360
Coral Springs, FL 33065-4146

Mailing address

2901 Coral Hills Dr
Suite 360
Coral Springs, FL 33065-4146
Phone (954) 255-7310

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111220000755 FL Part B Supplier - Clinic/Group Practice 8022284173 Receives reassigned benefits from 21 practitioners
Practice locations: Coral Springs, FL; Tamarac, FL; Plantation, FL; Lauderdale Lakes, FL

National Provider Directory

National Provider Directory

Locations

2901 Coral Hills Dr
Ste 360
Coral Springs, FL 33065
Phone (954) 255-7310

4900 W Oakland Park Blvd
Ste 107
Lauderdale Lakes, FL 33313
Phone (786) 401-6455

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1313107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313107200000",
    "number": "1497034086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 CORAL HILLS DR",
            "address_2": "SUITE 360",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330654146",
            "telephone_number": "954-255-7310",
            "fax_number": "954-255-7311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 CORAL HILLS DR",
            "address_2": "SUITE 360",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330654146",
            "telephone_number": "954-255-7310",
            "fax_number": "954-255-7311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCG OF SOUTH FLORIDA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-12",
        "last_updated": "2011-08-12",
        "status": "A",
        "authorized_official_last_name": "PEREIRA",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-255-7310",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coral Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2011; 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.