NPIMap

Organization Active NPI

PMR Illinois Holding, LLC

  • Specialist
  • Miami Gardens, FL
National Provider Identifier
1770038671
Registry record updated Aug 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PMR ILLINOIS HOLDING, LLC
Practice address
1395 NW 167TH St
Miami Gardens, FL 33169-5742
Phone
(305) 831-4760
NPI assigned
Aug 20, 2016
Last updated
Aug 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2016

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

Authorized official

Name
Mary Chen
Title
Chief Operating Officer
Phone
(305) 831-4760

Specialties & licenses 2

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

Addresses

Primary practice location

1395 NW 167TH St
Miami Gardens, FL 33169-5742

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5742
Phone (305) 831-4760

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220126001647 IL Part B Supplier - Clinic/Group Practice 2062804909 Receives reassigned benefits from 78 practitioners
Practice locations: Berwyn, IL; Chicago, IL; Dolton, IL; Glenwood, IL; Oak Lawn, IL

National Provider Directory

National Provider Directory
Tax ID family
PMR Illinois Holding LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

19310 S Halsted St
Glenwood, IL 60425
Phone (708) 300-3132

6101 W 95th St
Oak Lawn, IL 60453
Phone (708) 261-0831

Practitioners & affiliated clinicians

Practitioners 113

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 113

NPI Registry JSON

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

{
    "created_epoch": "1471651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471651200000",
    "number": "1770038671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695742",
            "telephone_number": "305-831-4760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695742",
            "telephone_number": "305-831-4760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMR ILLINOIS HOLDING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-20",
        "last_updated": "2016-08-20",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "305-831-4760"
    },
    "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 Miami Gardens, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2016; 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.