NPIMap

Organization Active NPI

Public Health Trust of Miami Dade County Florida

Doing business as Jefferson Reaves Sr Health Center

  • Multi-Specialty Clinic/Center
  • Miami, FL
National Provider Identifier
1851467666
Registry record updated Apr 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Doing business as
Jefferson Reaves Sr Health Center
Practice address
1009 NW 5TH Ave
Miami, FL 33136-3212
Phone
(786) 466-4000
Fax
(305) 577-1085
NPI assigned
Nov 27, 2006
Last updated
Apr 6, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 6, 2017

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

Authorized official

Name
Mr. Mark T Knight
Title
Chief Financial Officer
Phone
(305) 585-7979

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

1009 NW 5TH Ave
Miami, FL 33136-3212

Mailing address

PO Box 12493
Miami, FL 33101-2493
Phone (786) 466-8080

Other identifiers 1

IdentifierTypeStateIssuer
010042127MedicaidFL

Other names 1

  • Jefferson Reaves Sr Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851467666. Details of each certification follow.

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
GovernmentNon-profit
Enrollment address
1611 NW 12TH Ave
Miami, FL 33136-1005
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 22

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

View all 22

Care Compare: Hospital

Medicare Care Compare
Listed as
Jackson Health SystemCCN 100022 · All quality measures
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
10D0947917Jefferson Reaves Sr Health Center1009 NW 5TH Avenue, Miami, FL 33136Certificate of waiverDec 3, 2026

National Provider Directory

National Provider Directory
Tax ID family
Abdul Mmemon MD54 organizations share this tax ID, including this one
Part of
Abdul Mmemon MD

Organizations with this tax ID in the same state 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Myriam Torres Individual Corporate OfficerVP Revenue Cycle Management Mar 21, 2016
Corporate DirectorVP Revenue Cycle Management Mar 21, 2016
W-2 Managing EmployeeVP Revenue Cycle Management Mar 21, 2016
Operational/Managerial ControlVP Revenue Cycle Management Mar 21, 2016
Mark T Knight Individual Corporate OfficerEvp, Chief Financial Officer Nov 1, 2010
Corporate DirectorEvp, Chief Financial Officer Nov 1, 2011
W-2 Managing EmployeeEvp, Chief Financial Officer Nov 1, 2010
Operational/Managerial ControlEvp, Chief Financial Officer Nov 1, 2011
Carlos Migoya Individual Corporate OfficerChief Executive Officer May 2, 2011
Corporate DirectorChief Executive Officer May 2, 2011
W-2 Managing EmployeeChief Executive Officer May 2, 2011
Operational/Managerial ControlChief Executive Officer May 2, 2011
Public Health Trust of Miami Dade County Florida Organization, Miami, FL Non-profit Operational/Managerial Control Oct 1, 1973 100%

Owners & managing parties with NPI records 12

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 1,674

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,674

NPI Registry JSON

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491436800000",
    "number": "1851467666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12493",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331012493",
            "telephone_number": "786-466-8080",
            "fax_number": "305-355-5380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 NW 5TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331363212",
            "telephone_number": "786-466-4000",
            "fax_number": "305-577-1085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY",
        "enumeration_date": "2006-11-27",
        "last_updated": "2017-04-06",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "305-585-7979",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010042127",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Reaves Sr Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.