NPIMap

Organization Active NPI

Centrum Medical Holdings, LLC

  • Internal Medicine Physician
  • Hialeah, FL
National Provider Identifier
1780230268
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CENTRUM MEDICAL HOLDINGS, LLC
Practice address
900 W 49TH St Ste 308
Hialeah, FL 33012-3435
Phone
(305) 266-2929
NPI assigned
Aug 12, 2019
Last updated
Feb 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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

Authorized official

Name
Graciela V Victorero
Title
Coo
Phone
(305) 266-2929

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary
Clinic/Center 261Q00000X NU

Addresses

Primary practice location

900 W 49TH St Ste 308
Hialeah, FL 33012-3435

Mailing address

9250 NW 36TH St Ste 420
Doral, FL 33178-2775
Phone (305) 266-2929

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191223002085 FL Part B Supplier - Clinic/Group Practice 8820422991 Receives reassigned benefits from 82 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL; Miami Gardens, FL; Miami Shores, FL; Miramar, FL; North Miami Beach, FL; Sweetwater, FL; West Palm Beach, FL; Margate, FL…

Other NPIs on the same Medicare enrollment 29

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 29

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1780230268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9250 NW 36TH ST STE 420",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331782775",
            "telephone_number": "305-266-2929",
            "fax_number": "305-579-6673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W 49TH ST STE 308",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330123435",
            "telephone_number": "305-266-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRUM MEDICAL HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-12",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "VICTORERO",
        "authorized_official_first_name": "GRACIELA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "305-266-2929"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; 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.