Organization Active NPI

Dedicated Senior Medical Center Clearwater, LLC.

  • Specialist
  • Clearwater, FL
National Provider Identifier
1700310422
Registry record updated Apr 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
DEDICATED SENIOR MEDICAL CENTER CLEARWATER, LLC.
Practice address
855 S Highland Avenue
Dedicated Senior Medical Center St. Clearwater, LLC.
Clearwater, FL 33756
Phone
(305) 831-4761
NPI assigned
Apr 19, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2017

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

Authorized official

Name
Gladys Fernandez-Cortes
Title
Managing Director
Phone
(305) 498-4034

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary
Non-Pharmacy Dispensing Site 332900000X

Addresses

Primary practice location

855 S Highland Avenue
Dedicated Senior Medical Center St. Clearwater, LLC.
Clearwater, FL 33756

Mailing address

1395 NW 167TH Street
Chen Medical Corporate Office
Miami Gardens, FL 33169
Phone (305) 831-4761

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
10D2131668Dedicated Senior Medical Center - Clearwater855 S Highland Ave, Clearwater, FL 33756Certificate of waiverJun 4, 2027

National Provider Directory

National Provider Directory

Locations

855 S Highland Ave
Clearwater, FL 33756
Phone (727) 219-1833

NPI Registry JSON

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492560000000",
    "number": "1700310422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH STREET",
            "address_2": "CHEN MEDICAL CORPORATE OFFICE",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "33169",
            "telephone_number": "305-831-4761",
            "fax_number": "305-831-4761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 S HIGHLAND AVENUE",
            "address_2": "DEDICATED SENIOR MEDICAL CENTER ST. CLEARWATER, LLC.",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "33756",
            "telephone_number": "305-831-4761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEDICATED SENIOR MEDICAL CENTER CLEARWATER, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-19",
        "last_updated": "2017-04-19",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ-CORTES",
        "authorized_official_first_name": "GLADYS",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "305-498-4034"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY 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": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; 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.