Organization Active NPI

Good Shepherd Psychiatric Consultant, Inc

  • Assisted Living Facility
  • Pembroke Pines, FL
National Provider Identifier
1578711719
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
A11138 Issued in FL
Legal business name
GOOD SHEPHERD PSYCHIATRIC CONSULTANT, INC
Practice address
9050 Pines Blvd Ste 425-428
Pembroke Pines, FL 33024-6455
Phone
(954) 822-2754
NPI assigned
Aug 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

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

Authorized official

Name
Amir Shahzad
Title
Office Manager
Phone
(916) 974-9542

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X A11138 FL Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

9050 Pines Blvd Ste 425-428
Pembroke Pines, FL 33024-6455

Mailing address

510 NW 98TH St
Miami, FL 33150-1617
Phone (954) 822-2754

Other identifiers 2

IdentifierTypeStateIssuer
5000OtherFLMENTAL HEALTH
142787300MedicaidFL

Other names 1

  • Good Shepherd Psychiatric Consultant, INC Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Miami Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220125002076 FL Part B Supplier - Clinic/Group Practice 4587056577 Receives reassigned benefits from 1 practitioner
Practice locations: Pembroke Pines, FL

National Provider Directory

National Provider Directory

Locations

9050 Pines Blvd
Ste 425428
Pembroke Pines, FL 33024
Phone (954) 271-5676

Practitioners & affiliated clinicians

Practitioners 1

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": "1219968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692835200000",
    "number": "1578711719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 NW 98TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331501617",
            "telephone_number": "954-822-2754",
            "fax_number": "954-822-2754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9050 PINES BLVD STE 425-428",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330246455",
            "telephone_number": "954-822-2754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD PSYCHIATRIC CONSULTANT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-29",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A",
        "authorized_official_last_name": "SHAHZAD",
        "authorized_official_first_name": "AMIR",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "916-974-9542"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "A11138",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH",
            "identifier": "5000",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142787300",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Miami",
            "affiliation": "N",
            "endpointDescription": "Healthcare",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "510 NW 98th St",
            "city": "Miami",
            "state": "FL",
            "country_code": "US",
            "postal_code": "331501617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Good Shepherd Psychiatric Consultant, INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Pembroke Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; 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.