Organization Active NPI

Familiar Medical Center LLC

  • Internal Medicine Physician
  • Hialeah, FL
National Provider Identifier
1902458979
Registry record updated Nov 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
FAMILIAR MEDICAL CENTER LLC
Practice address
777 E 25TH St Ste 101
Hialeah, FL 33013-3804
Phone
(786) 953-5695
NPI assigned
Jul 10, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2024

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

Authorized official

Name
Dr. Jorge Diaz Valdes, MD
Title
Member
Phone
(786) 953-5695

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

777 E 25TH St Ste 101
Hialeah, FL 33013-3804

Mailing address

777 E 25TH St Ste 101
Hialeah, FL 33013-3804
Phone (786) 718-9661

Other practice location 1

9380 SW 150th St Ste 260
Miami, FL 33176-7947
Phone (305) 964-5582

Electronic endpoints 2

TypeEndpointUseAffiliation
Other URL AdvancedMD
Other URL AdvanceMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250603000309 FL Part B Supplier - Clinic/Group Practice 2961911862 Receives reassigned benefits from 1 practitioner
Practice locations: Hialeah, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2328857Familiar Medical Center LLC777 E 25TH Ste 101, Hialeah, FL 33013Certificate of waiverAug 18, 2027
10D2328861Familiar Medical Center LLC9380 SW 150TH St Ste 260, Miami, FL 33176Certificate of waiverAug 18, 2027

National Provider Directory

National Provider Directory

Locations

8000 NW 7th St
Ste 102
Miami, FL 33126
Phone (305) 400-8005

Practitioners & affiliated clinicians

Practitioners 2

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": "1562716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731542400000",
    "number": "1902458979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 E 25TH ST STE 101",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330133804",
            "telephone_number": "786-718-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 E 25TH ST STE 101",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330133804",
            "telephone_number": "786-953-5695"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9380 SW 150th St Ste 260",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331767947",
            "country_code": "US",
            "telephone_number": "305-964-5582",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAMILIAR MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-10",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A",
        "authorized_official_last_name": "VALDES",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "DIAZ",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "786-953-5695",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "AdvancedMD",
            "affiliation": "N",
            "address_1": "777 E 25th St Ste 101",
            "city": "Hialeah",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330133804",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "AdvanceMD",
            "affiliation": "N",
            "address_1": "777 E 25th St Ste 101",
            "city": "Hialeah",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330133804",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.