Public Health Trust of Miami Dade County Florida
Organization Active NPI Community Health Clinic/Center · Homestead, FL
NPI 1801966676 · NPPES record last updated Apr 6, 2017
Key facts
- NPI
- 1801966676
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- Legal business name
- PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
- Practice address
- 28205 SW 125TH Ave
Homestead, FL 33033-1250 - Phone
- (305) 416-7149
- Fax
- (305) 585-5259
- NPI assigned
- Nov 9, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY
Authorized official
- Name
- Mr. Mark T Knight
- Title
- Chief Financial Officer
- Phone
- (305) 585-7979
Owners & managing parties with NPI records 12
Other NPIs on the same Medicare enrollment 22
Corporate family (same tax ID) 19
Related certifications (CCN) 5
Affiliated clinicians 1,674
-
Miguel Abalo, MD
-
Barbara Gabriela Abaroa, CRNA
-
Naaman Abdullah, M.D.
-
Farhan Abid, M.D.
-
Adib Adnan Abla, MD
-
Muna Saleh Abraha, APRN
-
Thomas Abraham, M.D
-
Michelle J Abramson, CRNA
-
Andres Abreu, D.O
-
Rafael Abreu, M.D
-
Daniel Acevedo, MSN, CRNA
-
Alexis Acosta, APRN-BC
-
Brian Cody Adkinson, M.D.
-
Andrew Omoh Agbi, D.O
-
Gisela Aguila-Puentes, PSY.D.
Medicare Care Compare: Hospital
- Listed as
- Jackson Health System
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Type
- Acute Care Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2019668 | South Dade Homeless Assistance Health Center | Certificate of waiver | Feb 2, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Hospital certification: CCN 100022
- Legal name
- PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Jul 9, 2020
- Beds
- 2,255
- Ownership / control type
- Hospital district or authority
- Organization structure
- Government · Non-profit
- Enrollment address
- 1611 NW 12TH Ave
Miami, FL 33136-1005 - Hospital subgroups
- General, Acute care
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Myriam Torres |
Corporate Officer |
Mar 21, 2016 | |
| Corporate Director |
Mar 21, 2016 | ||
| W-2 Managing Employee |
Mar 21, 2016 | ||
| Operational/Managerial Control |
Mar 21, 2016 | ||
| Mark T Knight |
Corporate Officer |
Nov 1, 2010 | |
| Corporate Director |
Nov 1, 2011 | ||
| W-2 Managing Employee |
Nov 1, 2010 | ||
| Operational/Managerial Control |
Nov 1, 2011 | ||
| Carlos Migoya |
Corporate Officer |
May 2, 2011 | |
| Corporate Director |
May 2, 2011 | ||
| W-2 Managing Employee |
May 2, 2011 | ||
| Operational/Managerial Control |
May 2, 2011 | ||
| Public Health Trust of Miami Dade County Florida |
Operational/Managerial Control | Oct 1, 1973 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060208000214 | FL | Part a Provider - Hospital | 8628981925 |
22 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Miami, FL; North Miami Beach, FL; Miami Beach, FL; North Miami, FL; Opa Locka, FL; Village of Palmetto Bay, FL; Homestead, FL; Doral, FL… |
National Provider Directory
- Tax ID family
- Dianne M Parker MD
- Part of
- Dianne M Parker MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | Yes |
Addresses
Primary practice location
28205 SW 125TH Ave
Homestead, FL 33033-1250
Mailing address
PO Box 12493
Miami, FL 33101-2493
Phone (786) 466-8080
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010042135 | Medicaid | FL |
Other names
- South Dade Homeless Assistance Center
Other providers in Homestead, FL
- Promised Hands LLC
- Pros Miami Homestead, LLC
- Provider Associates Ipa
- Psychsync LLC
- Lisette Pubillones
- Publix Super Markets Inc
- Publix Super Markets Inc
- Publix Super Markets Inc
- Publix Super Markets Inc
- Publix Super Markets, Inc.
All providers in Homestead, FL · Community Health Clinic/Center in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.