NPIMap

Organization Active NPI

Conviva Medical Center Management LLC

  • Family Medicine Physician
  • Pembroke Pines, FL
National Provider Identifier
1942947346
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CONVIVA MEDICAL CENTER MANAGEMENT LLC
Practice address
12177 Pembroke Rd
Pembroke Pines, FL 33025-1727
Phone
(954) 436-0555
Fax
(954) 436-0108
NPI assigned
May 17, 2022
Organization subpart
Yes
Parent organization
CONVIVA MEDICAL CENTER MANAGEMENT LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Authorized official

Name
Kevin Meriwether
Title
Division President
Phone
(305) 500-2000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

12177 Pembroke Rd
Pembroke Pines, FL 33025-1727

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000

Other names 1

  • Conviva South Pembroke Other name

National Provider Directory

National Provider Directory
Tax ID family
Conviva Med Ctr MGMT LLC76 organizations share this tax ID, including this one
Part of
Conviva Med Ctr MGMT LLC

Organizations with this tax ID in the same state 19

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 19

Locations

6101 Waterford District Dr
Ste 200
Miami, FL 33126
Phone (407) 533-6836

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1652745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1942947346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12177 PEMBROKE RD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330251727",
            "telephone_number": "954-436-0555",
            "fax_number": "954-436-0108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVIVA MEDICAL CENTER MANAGEMENT LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONVIVA MEDICAL CENTER MANAGEMENT LLC",
        "enumeration_date": "2022-05-17",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A",
        "authorized_official_last_name": "MERIWETHER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "DIVISION PRESIDENT",
        "authorized_official_telephone_number": "305-500-2000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conviva South Pembroke",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Conviva South Pembroke",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pembroke Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.