Individual provider Active NPI

Rogerio S. Faillace, M.D.

  • Pediatrics Physician
  • Miramar, FL
National Provider Identifier
1902977663
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME 77924 Issued in FL
Practice address
1951 SW 172 Ave
Suite 304
Miramar, FL 33029
Phone
(954) 441-1144
Fax
(954) 441-4404
NPI assigned
Nov 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME 77924 FL Primary

Addresses

Primary practice location

1951 SW 172 Ave
Suite 304
Miramar, FL 33029

Mailing address

1951 SW 172 Avenue
Suite 304
Miramar, FL 33029
Phone (954) 441-1144

Other identifiers 1

IdentifierTypeStateIssuer
259184700MedicaidFL

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
I20041006000401 FL Practitioner - Pediatric Medicine 7911966932 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
72.47 of 100Reported as group
Quality
62.45
Improvement activities
40
Cost
73.28

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 77924FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nova Southeastern University Inc. CurrentSince Jan 1, 2015 Accepting new patients
Nova Southeastern University CurrentSince Jan 1, 2015 Accepting new patients
Nova Southeastern University, Inc Current Accepting new patients
Nova Southeastern University, Inc Pediatrics Past Accepting new patients
Orlando Health, Inc. Past Accepting new patients
Emergency Physician Enterprises Past Accepting new patients

Locations

3200 S University Dr
Davie, FL 33328
Phone (954) 262-1250

1600 S Andrews Ave
Ft Lauderdale, FL 33316
Phone (954) 355-4000

650 N Andrews Ave
Ft Lauderdale, FL 33311
Phone (954) 463-4213

1750 NE 167th St
North Miami Beach, FL 33162
Phone (305) 949-4000

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902977663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1951 SW 172 AVENUE",
            "address_2": "SUITE 304",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "33029",
            "telephone_number": "954-441-1144",
            "fax_number": "954-441-4404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1951 SW 172 AVE",
            "address_2": "SUITE 304",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "33029",
            "telephone_number": "954-441-1144",
            "fax_number": "954-441-4404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAILLACE",
        "first_name": "ROGERIO",
        "middle_name": "S.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME 77924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "259184700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miramar, FL

Sources for this page

Verify at the official NPI Registry.