NPIMap

Organization Active NPI

Phoenix Pediatrics of Broward LLC

  • Pediatrics Physician
  • Fort Lauderdale, FL
National Provider Identifier
1619970498
Registry record updated Jun 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PHOENIX PEDIATRICS OF BROWARD LLC
Practice address
1600 S Andrews Ave
Ft Lauderdale, FL 33316-2510
Phone
(954) 939-5000
Fax
(877) 250-6889
NPI assigned
May 24, 2005
Last updated
Jun 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2026

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

Authorized official

Name
Christopher Kennedy
Title
Authorized Official
Phone
(207) 807-9009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

1600 S Andrews Ave
Ft Lauderdale, FL 33316-2510

Mailing address

PO Box 781065
Philadelphia, PA 19178-1065
Phone (954) 939-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110707000584 FL Part B Supplier - Clinic/Group Practice 3173701554 Receives reassigned benefits from 25 practitioners
1 other NPI on this enrollment
Practice locations: Coral Springs, FL; Ft. Lauderdale, FL

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Pediatrics of Broward LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780358400000",
    "number": "1619970498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781065",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191781065",
            "telephone_number": "954-939-5000",
            "fax_number": "877-250-6889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S ANDREWS AVE",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162510",
            "telephone_number": "954-939-5000",
            "fax_number": "877-250-6889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX PEDIATRICS OF BROWARD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "207-807-9009"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; 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.