South Broward Hospital District

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

SOUTH BROWARD HOSPITAL DISTRICT

Doing business as

Memorial Division of Adult Psychiatry at MHP

Practice address

2301 N University Dr Ste 211
Pembroke Pines, FL 33024-3617

Phone

(954) 265-1260

Fax

(954) 265-1275

NPI assigned

Jun 10, 2021

Last updated

Jun 11, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

SOUTH BROWARD HOSPITAL DISTRICTAs reported in NPPES

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

Authorized official

Name

Esther Surujon

Title

Cfo Memorial Physician Group & MPC

Phone

(954) 265-6677

Specialties & licenses 1

Addresses

Other names 1

• Memorial Division of Adult Psychiatry at MHP Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• South Broward Hospital District

  dba Memorial Division of Psychiatry Services

  • Psychiatry Physician
  • Hollywood, FL
  • NPI 1417491127

  O20170321001407

  Same enrollment

Part of

Eddy H Carrillo MD

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

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623369600000",
    "number": "1881261485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 N UNIVERSITY DR STE 211",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330243617",
            "telephone_number": "954-265-1260",
            "fax_number": "954-265-1275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH BROWARD HOSPITAL DISTRICT",
        "enumeration_date": "2021-06-10",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A",
        "authorized_official_last_name": "SURUJON",
        "authorized_official_first_name": "ESTHER",
        "authorized_official_title_or_position": "CFO MEMORIAL PHYSICIAN GROUP & MPC",
        "authorized_official_telephone_number": "954-265-6677"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Division of Adult Psychiatry at MHP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Memorial Division of Adult Psychiatry at MHP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South Broward Hospital District (Memorial Division of Geriatric Medicine)
• South Broward Hospital District (Memorial West Outpatient Pharmacy)
• South Broward Hospital District (Memorial Division of General Surgery)
• South Broward Hospital District (Memorial Division of Cancer Institute)
• South Broward Hospital District (Memorial Division of Maternal Fetal Medicine)
• South Broward Kidney Assosciates PA
• South Broward Medical Management, Inc.
• South Broward Surgical Group LLC
• South Dental of Pembroke
• South Florida ADHD Center Inc.

• Psychiatry Physician in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; 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.