NPIMap

Organization Active NPI

PMR Georgia Holding, LLC

Doing business as Jencare Neighborhood Medical Center

  • Specialist
  • Miami Gardens, FL
National Provider Identifier
1609329630
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PMR GEORGIA HOLDING, LLC
Doing business as
Jencare Neighborhood Medical Center
Practice address
1395 NW 167TH St
Miami Gardens, FL 33169-5742
Phone
(305) 831-4760
NPI assigned
Jul 26, 2016
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Mary Chen
Title
Authorized Official
Phone
(305) 831-4722

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary
Non-Pharmacy Dispensing Site 332900000X

Addresses

Primary practice location

1395 NW 167TH St
Miami Gardens, FL 33169-5742

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (305) 628-6117

Other names 1

  • Jencare Neighborhood Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210409002172 GA Part B Supplier - Clinic/Group Practice 8426466590 Receives reassigned benefits from 64 practitioners
Practice locations: Decatur, GA; Morrow, GA; Forest Park, GA; East Point, GA; Atlanta, GA

National Provider Directory

National Provider Directory
Tax ID family
PMR Illinois Holding LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

Practitioners & affiliated clinicians

Practitioners 109

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 109

NPI Registry JSON

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

{
    "created_epoch": "1469491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1609329630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "305-628-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695742",
            "telephone_number": "305-831-4760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMR GEORGIA HOLDING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-26",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "305-831-4722"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jencare Neighborhood Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Miami Gardens, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; 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.