NPIMap

Organization Active NPI

Suramed Health Center, PA

  • Pediatrics Physician
  • Port St Lucie, FL
National Provider Identifier
1649896127
Registry record updated Dec 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SURAMED HEALTH CENTER, PA
Practice address
683 SW Port St Lucie Blvd
Port St Lucie, FL 34953-1998
Phone
(772) 204-2909
Fax
(772) 785-8138
NPI assigned
Jun 22, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2024

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

Authorized official

Name
Dr. Alfonso J Henriquez, MDNPI 1851449995
Title
Pediatrics
Phone
(772) 204-2909

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

683 SW Port St Lucie Blvd
Port St Lucie, FL 34953-1998

Mailing address

683 SW Port St Lucie Blvd
Port St Lucie, FL 34953-1998
Phone (561) 275-7100

Other identifiers 1

IdentifierTypeStateIssuer
009406903MedicaidFL

Other names 1

  • SURAMED HEALTH CENTER PA PORT SAINT LUCIE Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2197575Suramed Health Center PA683 SW Port St Lucie Blvd, Port Saint Lucie, FL 34953Certificate of waiverOct 25, 2026

National Provider Directory

National Provider Directory
Tax ID family
Suramed Health Center PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

683 SW Port St Lucie Blvd
Port St Lucie, FL 34953
Phone (772) 202-4290

Practitioners & affiliated clinicians

Practitioners 3

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": "1592784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734912000000",
    "number": "1649896127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "683 SW PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349531998",
            "telephone_number": "561-275-7100",
            "fax_number": "561-275-7199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "683 SW PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349531998",
            "telephone_number": "772-204-2909",
            "fax_number": "772-785-8138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURAMED HEALTH CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-22",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A",
        "authorized_official_last_name": "HENRIQUEZ",
        "authorized_official_first_name": "ALFONSO",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PEDIATRICS",
        "authorized_official_telephone_number": "772-204-2909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009406903",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SURAMED HEALTH CENTER PA PORT SAINT LUCIE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.