NPIMap

Organization Active NPI

South Broward Hospital District

Doing business as Memorial Primary Care Weston

  • General Practice Physician
  • Weston, FL
National Provider Identifier
1780368761
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
SOUTH BROWARD HOSPITAL DISTRICT
Doing business as
Memorial Primary Care Weston
Practice address
17130 Royal Palm Blvd
Weston, FL 33326-2311
Phone
(954) 276-1366
Fax
(954) 276-0386
NPI assigned
Jun 12, 2023
Last updated
Jun 12, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH BROWARD HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

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

Authorized official

Name
Esther Surujon
Title
Cfo MPG, MPC and Ucc
Phone
(954) 265-6677

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

17130 Royal Palm Blvd
Weston, FL 33326-2311

Mailing address

2900 Corporate Way
Door D
Miramar, FL 33025
Phone (954) 276-5685

Other names 1

  • Memorial Primary Care Weston Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230112002014 FL Part B Supplier - Hospital Department(S) 8123927373 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hollywood, FL; Weston, FL

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2278924Memorial Primary Care Weston17130 Royal Palm Blvd, Weston, FL 33326Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Memorial Hosp Div Ortho58 organizations share this tax ID, including this one
Part of
Memorial Hosp Div Ortho

Organizations with this tax ID in the same state 19

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

View all 19

Locations

17130 Royal Palm Blvd
Weston, FL 33326
Phone (954) 276-1366

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1780368761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "33025",
            "telephone_number": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17130 ROYAL PALM BLVD",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333262311",
            "telephone_number": "954-276-1366",
            "fax_number": "954-276-0386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "SURUJON",
        "authorized_official_first_name": "ESTHER",
        "authorized_official_title_or_position": "CFO MPG, MPC AND UCC",
        "authorized_official_telephone_number": "954-265-6677"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Primary Care Weston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Weston, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.