Active NPI
St Jude Medical Group Corp
Doing business as Vidamax Medical Center
- Clinic/Center
- Hialeah Gardens, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- ST JUDE MEDICAL GROUP CORP
- Doing business as
- Vidamax Medical Center
- Practice address
- 11300 NW 87TH CT Ste 141
Hialeah Gardens, FL 33018-4520 - Phone
- (786) 464-5120
- Fax
- (786) 464-5125
- NPI assigned
- Nov 25, 2024
- Last updated
- Nov 25, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Manuel D. Gonzalez, MD
- Title
- Medical Director
- Phone
- (786) 464-5120
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | NU | Primary |
Addresses
Primary practice location
11300 NW 87TH CT Ste 141
Hialeah Gardens, FL 33018-4520
Mailing address
2141 NW 7TH St
Miami, FL 33125-3483
Phone (786) 464-5120
Other names 1
- VIDAMAX MEDICAL CENTER
National Provider Directory
National Provider Directory- Tax ID family
- St Jude Medical Group Corp
Other organizations with this tax ID 5
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Vidamax Medical Center
- Internal Medicine Physician
- Miami, FL
- NPI 1952745580
Networks
- HealthSun Health Plans Network
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Internal Medicine Physician
- Miami, FL
- NPI 1356584361
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1732492800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1732492800000",
"number": "1982420998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2141 NW 7TH ST",
"city": "MIAMI",
"state": "FL",
"postal_code": "331253483",
"telephone_number": "786-464-5120",
"fax_number": "786-464-5125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11300 NW 87TH CT STE 141",
"city": "HIALEAH GARDENS",
"state": "FL",
"postal_code": "330184520",
"telephone_number": "786-464-5120",
"fax_number": "786-464-5125"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST JUDE MEDICAL GROUP CORP",
"organizational_subpart": "NO",
"enumeration_date": "2024-11-25",
"last_updated": "2024-11-25",
"certification_date": "2024-11-25",
"status": "A",
"authorized_official_last_name": "GONZALEZ",
"authorized_official_first_name": "MANUEL",
"authorized_official_middle_name": "D.",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "786-464-5120",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "VIDAMAX MEDICAL CENTER",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Hialeah Gardens, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.