NPIMap

Organization Active NPI

South Broward Hospital District

Doing business as Memorial Division of Critical Care

  • Critical Care Medicine (Internal Medicine) Physician
  • Hollywood, FL
National Provider Identifier
1609884154
Registry record updated Mar 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
Legal business name
SOUTH BROWARD HOSPITAL DISTRICT
Doing business as
Memorial Division of Critical Care
Practice address
3501 Johnson St
Hollywood, FL 33021-5421
Phone
(954) 265-9976
Fax
(954) 965-5396
NPI assigned
Aug 3, 2006
Last updated
Mar 13, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH BROWARD HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 13, 2018

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

Authorized official

Name
Nina Beauchesne
Title
Executive Vice President
Phone
(954) 265-3451

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X Primary

Addresses

Primary practice location

3501 Johnson St
Hollywood, FL 33021-5421

Mailing address

2900 Corporate Way
Door D
Miramar, FL 33025-3925
Phone (954) 276-5685

Other identifiers 1

IdentifierTypeStateIssuer
038184526MedicaidFL

Other names 1

  • Memorial Division of Critical Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040107000217 FL Part B Supplier - Clinic/Group Practice 8123927373 Receives reassigned benefits from 490 practitioners
17 other NPIs on this enrollment
Practice locations: Pembroke Pines, FL; Miramar, FL; Hollywood, FL; Wellington, FL; Weston, FL; Aventura, FL; Boca Raton, FL; Coral Springs, FL…

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory
Part of
Memorial Hospital Divis

Locations

3501 Johnson St
Fl 3
Hollywood, FL 33021
Phone (954) 265-9976

Networks

  • HealthSun Health Plans Network

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Memorial Hospital MiramarMiramar, FL, CCN 100285 Hospital Operational/Managerial Control
Other		 Mar 23, 2005
Mar 23, 2005
Memorial Regional HospitalHollywood, FL, CCN 100038 Hospital Operational/Managerial Control Jul 1, 1966
Memorial Rehabilitation InstituteHollywood, FL, CCN 10T038 Hospital Operational/Managerial Control Jun 1, 2017
Memorial Regional HospitalHollywood, FL, CCN 10S038 Hospital Operational/Managerial Control
Other		 Jan 1, 2016
Jan 1, 2020
Memorial Hospital WestPembroke Pines, FL, CCN 100281 Hospital Operational/Managerial Control
Other		 Feb 18, 2022
Oct 14, 2013
Memorial Hospital PembrokePembroke Pines, FL, CCN 100230 Hospital Operational/Managerial Control
Other		 Apr 1, 2020
Apr 1, 2020
Memorial Manor Nursing HomePembroke Pines, FL, CCN 105668 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jun 3, 1989
Jun 3, 1989

Practitioners & affiliated clinicians

Practitioners 500

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 500

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520899200000",
    "number": "1609884154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 JOHNSON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215421",
            "telephone_number": "954-265-9976",
            "fax_number": "954-965-5396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "enumeration_date": "2006-08-03",
        "last_updated": "2018-03-13",
        "status": "A",
        "authorized_official_last_name": "BEAUCHESNE",
        "authorized_official_first_name": "NINA",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "954-265-3451"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038184526",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Division of Critical Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.