Organization Active NPI

Bethesda Medical Clinic, LLC

  • Internal Medicine Physician
  • Davie, FL
National Provider Identifier
1710450267
Registry record updated Jul 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
BETHESDA MEDICAL CLINIC, LLC
Practice address
11050 Griffin Rd Ste 104
Davie, FL 33328-3227
Phone
(954) 824-1922
Fax
(954) 281-9446
NPI assigned
Jan 8, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2026

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

Authorized official

Name
Dr. Shibu VarugheseNPI 1346475506
Title
Medical Director
Phone
(504) 265-8304

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X

Addresses

Primary practice location

11050 Griffin Rd Ste 104
Davie, FL 33328-3227

Mailing address

11050 Griffin Rd Ste 104
Davie, FL 33328-3227
Phone (954) 824-1922

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260526000546 FL Part B Supplier - Clinic/Group Practice 7416427059 Receives reassigned benefits from 2 practitioners
Practice locations: Davie, FL

National Provider Directory

National Provider Directory

Locations

1151 Barataria Blvd
Ste 3400
Marrero, LA 70072
Phone (504) 265-8304

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EHFGBD

Practitioners & affiliated clinicians

Practitioners 5

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": "1546905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783296000000",
    "number": "1710450267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 GRIFFIN RD STE 104",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333283227",
            "telephone_number": "954-824-1922",
            "fax_number": "954-281-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 GRIFFIN RD STE 104",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333283227",
            "telephone_number": "954-824-1922",
            "fax_number": "954-281-9446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHESDA MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-08",
        "last_updated": "2026-07-06",
        "certification_date": "2026-07-06",
        "status": "A",
        "authorized_official_last_name": "VARUGHESE",
        "authorized_official_first_name": "SHIBU",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "504-265-8304",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 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.