NPIMap

Organization Active NPI

Jessie Trice Community Health System Inc

  • Federally Qualified Health Center (FQHC)
  • Carol City, FL
National Provider Identifier
1861863458
Registry record updated Nov 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JESSIE TRICE COMMUNITY HEALTH SYSTEM INC
Practice address
3301 Miami Gardens Drive
Carol City, FL 33056-2999
Phone
(305) 637-6400
Fax
(305) 636-5155
NPI assigned
Oct 8, 2015
Last updated
Nov 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2024

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

Authorized official

Name
Ryan R Hawkins
Title
President/Ceo
Phone
(305) 805-1700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3301 Miami Gardens Drive
Carol City, FL 33056-2999

Mailing address

5607 NW 27TH Ave
Suite 1
Miami, FL 33142-2826
Phone (305) 805-1700

Other identifiers 1

IdentifierTypeStateIssuer
029541858MedicaidFL

Other names 2

  • Jessie Trice Community Health Center Inc Former legal business name
  • Miami Carol City Senior High School Other name

National Provider Directory

National Provider Directory
Tax ID family
Economic Opportunity FH15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

3301 NW 183rd St
Carol City, FL 33056

NPI Registry JSON

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

{
    "created_epoch": "1444262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732665600000",
    "number": "1861863458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5607 NW 27TH AVE",
            "address_2": "SUITE 1",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331422826",
            "telephone_number": "305-805-1700",
            "fax_number": "305-805-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 MIAMI GARDENS DRIVE",
            "city": "CAROL CITY",
            "state": "FL",
            "postal_code": "330562999",
            "telephone_number": "305-637-6400",
            "fax_number": "305-636-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSIE TRICE COMMUNITY HEALTH SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-08",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "305-805-1700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029541858",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jessie Trice Community Health Center Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Miami Carol City Senior High School",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Miami Carol City Senior High School",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Carol City, FL

Sources for this page

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