NPIMap

Organization Active NPI

Public Health Trust of Miami Dade County Florida

Doing business as Jackson Pharmacy -West -52081

  • Community/Retail Pharmacy
  • Doral, FL
National Provider Identifier
1730767971
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Doing business as
Jackson Pharmacy -West -52081
Practice address
2801 NW 79TH Ave
Doral, FL 33122-1174
Phone
(786) 466-1010
NPI assigned
Mar 30, 2021
Last updated
Mar 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Authorized official

Name
Mark T Knight
Title
Evp Cfo
Phone
(305) 585-7979

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

2801 NW 79TH Ave
Doral, FL 33122-1174

Mailing address

PO Box 12493
Miami, FL 33101-2493
Phone (786) 466-8101

Other names 1

  • Jackson Pharmacy -West -52081 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211119001781 FL DME Supplier - Pharmacy 8628981925 Practice locations: Doral, FL

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
David E Perloff54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Networks

  • HealthSun Health Plans Network

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Public Health Trust of Miami Dade County FloridaMiami, FL, CCN 100022 Hospital Operational/Managerial Control (100%) Oct 1, 1973
Jackson Memorial Long Term Care CenterMiami, FL, CCN 105392 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Adp of the SNF		 Apr 25, 1992
Apr 25, 1992
May 5, 2025
Public Health Trust of Miami Dade County FloridaCutler Bay, FL, CCN 105252 Skilled nursing facility 5% Or Greater Direct Ownership Interest
Operational/Managerial Control
Adp of the SNF		 Oct 1, 1973
Oct 1, 1973
Oct 1, 1973

Owned or controlled facilities with NPI records 25

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1617062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617062400000",
    "number": "1730767971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12493",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331012493",
            "telephone_number": "786-466-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 NW 79TH AVE",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331221174",
            "telephone_number": "786-466-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-30",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "EVP CFO",
        "authorized_official_telephone_number": "305-585-7979"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Pharmacy -West -52081",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Doral, FL

Sources for this page

Verify at the official NPI Registry.