Broward Palm Medical Center 1, LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

BROWARD PALM MEDICAL CENTER 1, LLC

Practice address

6849 Taft Street
Hollywood, FL 33024

Phone

(303) 913-7300

Fax

(305) 362-4776

NPI assigned

May 29, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Santiago Moises

Title

Director of Centers Operations

Phone

(786) 362-4173

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Networks

• HealthSun Health Plans Network

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401321600000",
    "number": "1992117600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6849 TAFT ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330245601",
            "telephone_number": "305-913-7300",
            "fax_number": "305-362-4776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6849 TAFT STREET",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "33024",
            "telephone_number": "303-913-7300",
            "fax_number": "305-362-4776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROWARD PALM MEDICAL CENTER 1, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-29",
        "last_updated": "2014-05-29",
        "status": "A",
        "authorized_official_last_name": "MOISES",
        "authorized_official_first_name": "SANTIAGO",
        "authorized_official_title_or_position": "DIRECTOR OF CENTERS OPERATIONS",
        "authorized_official_telephone_number": "786-362-4173",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Exclusive Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.