Individual provider Active NPI

Fidel H Henriquez, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Pembroke Pines, FL
National Provider Identifier
1891738720
Registry record updated May 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
ME0058002 Issued in FL
Practice address
10796 Pines Blvd
Suite 103
Pembroke Pines, FL 33026-3905
Phone
(954) 442-1402
Fax
(954) 442-1418
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 17, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X ME0058002 FL Primary

Addresses

Primary practice location

10796 Pines Blvd
Suite 103
Pembroke Pines, FL 33026-3905

Mailing address

10796 Pines Blvd
Suite 103
Pembroke Pines, FL 33026-3905
Phone (954) 442-1402

Other identifiers 1

IdentifierTypeStateIssuer
ME0058002OtherFLLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041101000800 FL Practitioner - Endocrinology 7719949817 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fidel Hernando Henriquez MD PAGroup PAC ID 1951301845, 2 clinicians

Practice addresses (Care Compare)

10796 Pines Blvd
Suite 103
Pembroke Pines, FL 33026-3919

Hospital & facility affiliations

  • Memorial Hospital West Hospital, Pembroke Pines, FL, CCN 100281
  • Memorial Hospital Miramar Hospital, Miramar, FL, CCN 100285
  • Memorial Regional Hospital Hospital, Hollywood, FL, CCN 100038
  • Memorial Hospital Pembroke Hospital, Pembroke Pines, FL, CCN 100230

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME0058002FLMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fidel Hernando Henriquez MD PA Endocrinology, Diabetes & Metabolism CurrentSince Jun 1, 2006 Accepting new patients
Advanced Diabetes Treatment Centers LLC Endocrinology, Diabetes & Metabolism Past Accepting new patients

Locations

10796 Pines Blvd
Ste 103
Pembroke Pines, FL 33026
Phone (954) 442-1402

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494979200000",
    "number": "1891738720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10796 PINES BLVD",
            "address_2": "SUITE 103",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330263905",
            "telephone_number": "954-442-1402",
            "fax_number": "954-442-1418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10796 PINES BLVD",
            "address_2": "SUITE 103",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330263905",
            "telephone_number": "954-442-1402",
            "fax_number": "954-442-1418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRIQUEZ",
        "first_name": "FIDEL",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2017-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "FL",
            "license": "ME0058002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "ME0058002",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.