NPIMap

Organization Active NPI

CCG Palliative Care Services, LLC

  • Internal Medicine Physician
  • Plantation, FL
National Provider Identifier
1811401805
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME104716 Issued in FL
Legal business name
CCG PALLIATIVE CARE SERVICES, LLC
Practice address
8251 W Broward Blvd Ste 103
Plantation, FL 33324-2703
Phone
(954) 255-7310
Fax
(954) 255-7311
NPI assigned
Nov 29, 2017
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Dr. Mario B Pereira, MDNPI 1760680466
Title
MD
Phone
(954) 255-7310

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME104716 FL Primary

Addresses

Primary practice location

8251 W Broward Blvd Ste 103
Plantation, FL 33324-2703

Mailing address

8251 W Broward Blvd Ste 103
Plantation, FL 33324-2703
Phone (954) 255-7310

Other practice location 1

2901 Coral Hills Dr Ste 360
Coral Springs, FL 33065-4146
Phone (954) 255-7310

National Provider Directory

National Provider Directory

Locations

2901 Coral Hills Dr
Ste 360
Coral Springs, FL 33065
Phone (954) 255-7310

Practitioners & affiliated clinicians

Practitioners 1

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": "1511913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1811401805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8251 W BROWARD BLVD STE 103",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333242703",
            "telephone_number": "954-255-7310",
            "fax_number": "954-255-7311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8251 W BROWARD BLVD STE 103",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333242703",
            "telephone_number": "954-255-7310",
            "fax_number": "954-255-7311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2901 Coral Hills Dr Ste 360",
            "address_purpose": "LOCATION",
            "city": "Coral Springs",
            "state": "FL",
            "postal_code": "330654146",
            "country_code": "US",
            "telephone_number": "954-255-7310",
            "fax_number": "954-255-7311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CCG PALLIATIVE CARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-29",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "PEREIRA",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "954-255-7310",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME104716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plantation, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.