NPIMap

Organization Active NPI

California Club Medical Center LLC

  • Family Medicine Physician
  • North Miami Beach, FL
National Provider Identifier
1538106919
Registry record updated Jul 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
HCC6244 Issued in FL
Legal business name
CALIFORNIA CLUB MEDICAL CENTER LLC
Practice address
850 Ives Dairy Road
Unit 14
North Miami Beach, FL 33179
Phone
(305) 405-0365
Fax
(305) 405-0370
NPI assigned
Jun 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2008

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

Authorized official

Name
Mark Grnja IV, D.O.
Title
Cfo
Phone
(954) 929-3400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X FL
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X HCC6244 FL Primary

Addresses

Primary practice location

850 Ives Dairy Road
Unit 14
North Miami Beach, FL 33179

Mailing address

850 Ives Dairy Road
Unit 14
North Miami Beach, FL 33179
Phone (305) 405-0365

National Provider Directory

National Provider Directory

Locations

790 Ives Dairy Rd
#5W
North Miami Beach, FL 33179
Phone (305) 405-0365

Practitioners & affiliated clinicians

Practitioners 9

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": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217462400000",
    "number": "1538106919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 IVES DAIRY ROAD",
            "address_2": "UNIT 14",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "33179",
            "telephone_number": "305-405-0365",
            "fax_number": "305-405-0370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 IVES DAIRY ROAD",
            "address_2": "UNIT 14",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "33179",
            "telephone_number": "305-405-0365",
            "fax_number": "305-405-0370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA CLUB MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2008-07-31",
        "status": "A",
        "authorized_official_last_name": "GRNJA",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "954-929-3400",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "HCC6244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Miami Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.