NPIMap

Organization Active NPI

Banyan Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lauderdale Lakes, FL
National Provider Identifier
1972979631
Registry record updated Apr 15, 2025
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
4900 W Oakland Park Blvd FL 3
Lauderdale Lakes, FL 33313-7500
Phone
(305) 398-6100
NPI assigned
Aug 18, 2015
Last updated
Apr 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2025

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

Addresses

Primary practice location

4900 W Oakland Park Blvd FL 3
Lauderdale Lakes, FL 33313-7500

Mailing address

2300 NW 89TH PL FL 3
Doral, FL 33172-2431
Phone (305) 398-6100

Other identifiers 3

IdentifierTypeStateIssuer
013881915MedicaidFL
013881916MedicaidFL
014042500MedicaidFL

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
O20230713000840 FL Part A Provider - Federally Qualified Health Center (FQHC) 0547410011 Practice locations: Lauderdale Lakes, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972979631. Details of each certification follow.

Federally qualified health center certification: CCN 691185

Legal name
BANYAN COMMUNITY HEALTH CENTER, INC
Doing business as
BANYAN HEALTH SYSTEMS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 12, 2023
Last certification
Jul 12, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 30, 2010 in FL
Enrollment address
4900 W Oakland Park Blvd
Ste 101
Lauderdale Lakes, FL 33313-1555

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
Tax ID family
Banyan Community Health Center Inc18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

10 NW 42nd Ave
Ste 500
Miami, FL 33126
Phone (305) 643-7800

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • HealthSun Health Plans Network
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Manuel Fernandez Individual Corporate DirectorExecutive Vice President Feb 1, 2024
Mark Guthrie Individual Corporate Officer Jun 18, 2018
W-2 Managing Employee Jun 18, 2018
Operational/Managerial Control Jun 18, 2018

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 51

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 51

NPI Registry JSON

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

{
    "created_epoch": "1439856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744675200000",
    "number": "1972979631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 NW 89TH PL FL 3",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331722431",
            "telephone_number": "305-398-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 W OAKLAND PARK BLVD FL 3",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333137500",
            "telephone_number": "305-398-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANYAN COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-18",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "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": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013881915",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013881916",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014042500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lauderdale Lakes, FL

Sources for this page

Verify at the official NPI Registry.