NPIMap

Organization Active NPI

Banyan Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Coral Gables, FL
National Provider Identifier
1922349737
Registry record updated Oct 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BANYAN COMMUNITY HEALTH CENTER, INC.
Practice address
3850 W Flagler St
Coral Gables, FL 33134-1604
Phone
(305) 774-3400
Fax
(305) 643-7807
NPI assigned
Mar 5, 2013
Last updated
Oct 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2026

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

Authorized official

Name
Manuel Andres FernandezNPI 1881959948
Title
Ceo
Phone
(561) 213-9211

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

3850 W Flagler St
Coral Gables, FL 33134-1604

Mailing address

1200 NW 78TH Ave Ste 100
Doral, FL 33126-1816
Phone (305) 398-6100

Other identifiers 2

IdentifierTypeStateIssuer
012558506MedicaidFL
013881902MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121017000910 FL Part B Supplier - Clinic/Group Practice 0547410011 Receives reassigned benefits from 41 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lauderdale Lakes, FL; Cutler Bay, FL; Coral Gables, FL
O20150409000047 FL Part A Provider - Federally Qualified Health Center (FQHC) 0547410011 Practice locations: Coral Gables, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922349737. Details of each certification follow.

Federally qualified health center certification: CCN 681012

Legal name
BANYAN COMMUNITY HEALTH CENTER, INC
Doing business as
BANYAN HEALTH SYSTEMS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 9, 2015
Last certification
Apr 9, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 30, 2010 in FL
Enrollment address
3850 W Flagler St
Coral Gables, FL 33134-1604

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Networks

  • HealthSun Health Plans Network

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Manuel Vega Individual Corporate DirectorBoard of Directors Aug 1, 2010
Gina Basile Individual Corporate DirectorBoard of Directors Aug 1, 2010
Manuel Fernandez Individual Corporate DirectorExecutive Vice President Feb 1, 2024
Jorge Fernandez Individual Corporate DirectorBoard of Directors Jul 1, 2013
Carolyn Guerra Individual Corporate DirectorBoard of Directors Jun 1, 2013
Michel Duchaussee Individual Contracted Managing EmployeeCeo, Chairman of the Board, VP D Jun 1, 2010
Corporate OfficerCeo, Chairman of the Board, VP D Jun 1, 2010
Corporate DirectorCeo, Chairman of the Board, VP D Jun 1, 2010
W-2 Managing EmployeeCeo, Chairman of the Board, VP D Jun 1, 2010
Operational/Managerial ControlCeo, Chairman of the Board, VP D Jun 1, 2010
Denise Johnson Individual Corporate DirectorBoard of Directors Apr 1, 2014
Ileana Garcia Individual Contracted Managing EmployeeCeo, Coo, Chairman of the Boa Jun 1, 2010
Corporate OfficerCeo, Coo, Chairman of the Board Jun 1, 2010
Corporate DirectorCoo Jun 1, 2010
W-2 Managing EmployeeCoo Jun 1, 2010
Operational/Managerial ControlCeo, Coo, Chairman of the Board Jun 1, 2010
Lourdes Abadin Individual Corporate OfficerBoard of Directors Jul 1, 2013
Angel Rivera Individual Corporate DirectorBoard of Directors Nov 1, 2014
Jorge Balcazar Individual W-2 Managing EmployeeCfo Feb 3, 2014
Connolly D'Souza Individual Corporate DirectorBoard of Directors Mar 1, 2013

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Banyan Health Systems, Inc.Coral Gables, FL, CCN 681011 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 30, 2010
Banyan Health Systems IncCoral Gables, FL, CCN 681013 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 29, 2014

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1362441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791417600000",
    "number": "1922349737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NW 78TH AVE STE 100",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331261816",
            "telephone_number": "305-398-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 W FLAGLER ST",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331341604",
            "telephone_number": "305-774-3400",
            "fax_number": "305-643-7807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANYAN COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-05",
        "last_updated": "2026-10-08",
        "certification_date": "2026-10-08",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "ANDRES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-213-9211"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012558506",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013881902",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coral Gables, FL

Sources for this page

Verify at the official NPI Registry.