Organization Active NPI

Meridian Medical Group LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Miami, FL
National Provider Identifier
1912815754
Registry record updated Sep 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
MERIDIAN MEDICAL GROUP LLC
Practice address
9885 SW 123Rd Terrace
Miami, FL 33176
Phone
(305) 396-1701
Fax
(645) 231-2225
NPI assigned
Sep 1, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2026

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

Authorized official

Name
Stephan Dimitrjevitch, APRN, PMHNP
Title
Managing Member
Phone
(305) 396-1701

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

9885 SW 123Rd Terrace
Miami, FL 33176

Mailing address

13818 SW 152ND St # 216
Miami, FL 33177-1164
Phone (305) 396-1701

NPI Registry JSON

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

{
    "created_epoch": "1788220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788220800000",
    "number": "1912815754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13818 SW 152ND ST # 216",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331771164",
            "telephone_number": "305-396-1701",
            "fax_number": "645-231-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9885 SW 123RD TERRACE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33176",
            "telephone_number": "305-396-1701",
            "fax_number": "645-231-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERIDIAN MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-01",
        "last_updated": "2026-09-01",
        "certification_date": "2026-08-28",
        "status": "A",
        "authorized_official_last_name": "DIMITRJEVITCH",
        "authorized_official_first_name": "STEPHAN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "305-396-1701",
        "authorized_official_credential": "APRN, PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Sep 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.