Active NPI
North Broward Hospital District
Doing business as CCC Extension
- Family Medicine Physician
- Fort Lauderdale, FL
National Provider Identifier
1700912797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- NORTH BROWARD HOSPITAL DISTRICT
- Doing business as
- CCC Extension
- Practice address
- 200 NW 7TH Avenue
Fort Lauderdale, FL 33311-9026 - Phone
- (954) 759-6988
- Fax
- (954) 759-6701
- NPI assigned
- Feb 26, 2007
- Last updated
- May 25, 2021
- Organization subpart
- Yes
- Parent organization
- NORTH BROWARD HOSPITAL DISTRICT
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Alexander Fernandez
- Title
- SVP/Cfo
- Phone
- (954) 473-7642
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
200 NW 7TH Avenue
Fort Lauderdale, FL 33311-9026
Mailing address
1700 NW 49TH St Ste 125
Fort Lauderdale, FL 33309-3763
Phone (954) 759-6988
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 253794062 | Medicaid | FL | |
| 00020 | Other | FL | BCBS |
Other names 1
- CCC Extension
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040405001860 | FL | Part B Supplier - Clinic/Group Practice | 3577472422 |
Receives reassigned benefits from 251 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Part of
- NBHD Imperial Point Med
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1621900800000",
"number": "1700912797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 NW 49TH ST STE 125",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333093763",
"telephone_number": "954-759-6988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 NW 7TH AVENUE",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333119026",
"telephone_number": "954-759-6988",
"fax_number": "954-759-6701"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NORTH BROWARD HOSPITAL DISTRICT",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "NORTH BROWARD HOSPITAL DISTRICT",
"enumeration_date": "2007-02-26",
"last_updated": "2021-05-25",
"certification_date": "2021-05-25",
"status": "A",
"authorized_official_last_name": "FERNANDEZ",
"authorized_official_first_name": "ALEXANDER",
"authorized_official_title_or_position": "SVP/CFO",
"authorized_official_telephone_number": "954-473-7642"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "253794062",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "00020",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CCC Extension",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fort Lauderdale, FL
- North Broward Hospital District (Broward Health 7th Avenue Social Services)
- North Broward Hospital District (BH Physicians Main)
- North Broward Hospital District (BHP Mobile Health Center 02 (BHP Mobile Health))
- North Broward Hospital District (Bernard P. Alicki Health Center Pharmacy)
- North Broward Hospital District (BH Physicians Main)
- North Broward Hospital District (BHPG Womens Specialty Care)
- North Broward Hospital District (BHMC Op Wound Care)
- North Broward Hospital District (BH Physicians Main)
- North Broward Hospital District
- North Broward Hospital District (BHPG Mob 1625 Pulmo 610)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; 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.