NPIMap

Organization Active NPI

Innovative Cancer Institute LLC

  • Radiation Oncology Physician
  • South Miami, FL
National Provider Identifier
1881097673
Registry record updated Oct 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
ME58411 Issued in FL
Legal business name
INNOVATIVE CANCER INSTITUTE LLC
Practice address
5995 SW 71St St
#1B
South Miami, FL 33143-3500
Phone
(305) 669-6833
Fax
(305) 666-4030
NPI assigned
Oct 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2014

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

Authorized official

Name
Dr. Beatriz E Amendola, MDNPI 1073511333
Title
Medical Director
Phone
(305) 669-6833

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0001X ME58411 FL Primary

Addresses

Primary practice location

5995 SW 71St St
#1B
South Miami, FL 33143-3500

Mailing address

5995 SW 71St St
#1B
South Miami, FL 33143-3500
Phone (305) 669-6833

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080811000786 FL Part B Supplier - Clinic/Group Practice 3476627357 Receives reassigned benefits from 3 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hialeah, FL; South Miami, FL

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Innovative Cancer Institute LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412640000000",
    "number": "1881097673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5995 SW 71ST ST",
            "address_2": "#1B",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "331433500",
            "telephone_number": "305-669-6833",
            "fax_number": "305-666-4030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5995 SW 71ST ST",
            "address_2": "#1B",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "331433500",
            "telephone_number": "305-669-6833",
            "fax_number": "305-666-4030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE CANCER INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-07",
        "last_updated": "2014-10-07",
        "status": "A",
        "authorized_official_last_name": "AMENDOLA",
        "authorized_official_first_name": "BEATRIZ",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "305-669-6833",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": "FL",
            "license": "ME58411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.