Community Health of South Florida, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

COMMUNITY HEALTH OF SOUTH FLORIDA, INC.

Practice address

18050 Homestead Ave
Perrine, FL 33157-5529

Phone

(305) 238-9520

NPI assigned

Nov 17, 2008

Last updated

Sep 19, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brodes H Hartley Jr.

Title

Ceo

Phone

(305) 253-5100

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• RR Moton Elementary Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932354065. Details of each certification follow.

• CCN 101017 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 101017

Legal name

R R MOTON ELEMENTARY SCHOOL

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Apr 9, 2009

Last certification

Apr 9, 2009

Ownership / control type

For profit – corporation

Facility address

18050 Homestead Avenue
Perrine, FL 33157

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

{
    "created_epoch": "1226880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379548800000",
    "number": "1932354065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10300 SW 216TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331901003",
            "telephone_number": "305-253-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18050 HOMESTEAD AVE",
            "city": "PERRINE",
            "state": "FL",
            "postal_code": "331575529",
            "telephone_number": "305-238-9520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH OF SOUTH FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-17",
        "last_updated": "2013-09-19",
        "status": "A",
        "authorized_official_last_name": "HARTLEY",
        "authorized_official_first_name": "BRODES",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-253-5100",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029572838",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029572826 - FQHC",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RR Moton Elementary",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Community Health of South Florida Inc
• M D M Home Health Corporation

• Federally Qualified Health Center (FQHC) in Perrine, FL
• Providers in Perrine, FL by specialty
• Federally Qualified Health Center (FQHC) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.