Organization Active NPI

Trinity Community Health Center, LLC.

  • Family Medicine Physician
  • Miramar, FL
National Provider Identifier
1669063236
Registry record updated May 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TRINITY COMMUNITY HEALTH CENTER, LLC.
Practice address
3156 S University Dr
Miramar, FL 33025-3001
Phone
(786) 234-2519
Fax
(786) 590-1903
NPI assigned
Jan 27, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2023

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

Authorized official

Name
Jean Claude Medina, AP-APRN
Title
Advanced Practice Registered Nurse
Phone
(754) 217-3929

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X
Community Health Clinic/Center 261QC1500X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Primary Care Clinic/Center 261QP2300X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

3156 S University Dr
Miramar, FL 33025-3001

Mailing address

3156 S University Dr
Miramar, FL 33025-3001
Phone (754) 217-3929

Other identifiers 3

IdentifierTypeStateIssuer
1235683822OtherFLNPI
1336371129OtherFLDO (DOCTOR OF OSTEOPATHIC)
1427400720OtherFLNPI

Other names 1

  • TRINITY COMMUNITY HEALTH CENTER, LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211222000024 FL Part B Supplier - Clinic/Group Practice 6002207339 Receives reassigned benefits from 1 practitioner
Practice locations: Miramar, FL

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
10D2263442Trinity Community Health Center LLC3156 S University Drive, Miramar, FL 33025Certificate of waiverJun 27, 2028

National Provider Directory

National Provider Directory

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": "1611705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683676800000",
    "number": "1669063236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3156 S UNIVERSITY DR",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253001",
            "telephone_number": "754-217-3929",
            "fax_number": "754-217-3931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3156 S UNIVERSITY DR",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253001",
            "telephone_number": "786-234-2519",
            "fax_number": "786-590-1903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY COMMUNITY HEALTH CENTER, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-27",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "CLAUDE",
        "authorized_official_title_or_position": "ADVANCED PRACTICE REGISTERED NURSE",
        "authorized_official_telephone_number": "754-217-3929",
        "authorized_official_credential": "AP-APRN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1235683822",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DO (DOCTOR OF OSTEOPATHIC)",
            "identifier": "1336371129",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1427400720",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRINITY COMMUNITY HEALTH CENTER, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Miramar, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.