NPIMap

Organization Active NPI

Camillus Health Concern, Inc.

  • Federally Qualified Health Center (FQHC)
  • Miami, FL
National Provider Identifier
1902061617
Registry record updated Jul 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAMILLUS HEALTH CONCERN, INC.
Practice address
1603 NW 7TH Ave
Miami, FL 33136-1415
Phone
(305) 374-1065
Fax
(305) 372-1402
NPI assigned
Jul 22, 2008
Last updated
Jul 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2014

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

Authorized official

Name
Shedrick Boren, PH.D.
Title
Executive Director
Phone
(305) 577-4840

Specialties & licenses 1

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

Addresses

Primary practice location

1603 NW 7TH Ave
Miami, FL 33136-1415

Mailing address

336 NW 5TH St
Miami, FL 33128-1616
Phone (305) 577-4840

Other identifiers 2

IdentifierTypeStateIssuer
680002507MedicaidFL
680002506MedicaidFL

Other names 1

  • Camillus House Shelter Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040116000614 FL Part B Supplier - Clinic/Group Practice 4688575210 Receives reassigned benefits from 30 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404950400000",
    "number": "1902061617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 NW 5TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331281616",
            "telephone_number": "305-577-4840",
            "fax_number": "305-373-7431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603 NW 7TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331361415",
            "telephone_number": "305-374-1065",
            "fax_number": "305-372-1402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMILLUS HEALTH CONCERN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-22",
        "last_updated": "2014-07-10",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "SHEDRICK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "305-577-4840",
        "authorized_official_credential": "PH.D."
    },
    "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": "680002507",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "680002506",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camillus House Shelter",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.