NPIMap

Organization Active NPI

Mercy Medical Development Inc

  • Diagnostic Radiology Physician
  • Miami, FL
National Provider Identifier
1992787576
Registry record updated May 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MERCY MEDICAL DEVELOPMENT INC
Practice address
3641 S Miami Ave
Miami, FL 33133-4205
Phone
(305) 860-4660
Fax
(305) 860-4682
NPI assigned
Nov 18, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2008

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

Authorized official

Name
Mr. Jerry Mashburn
Title
Cfo
Phone
(305) 854-4400

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Nuclear Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207UN0901X
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X
Nuclear Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085N0904X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary
Therapeutic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0203X
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X
Diagnostic Ultrasound PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085U0001X

Addresses

Primary practice location

3641 S Miami Ave
Miami, FL 33133-4205

Mailing address

PO Box 331966
Miami, FL 33233-1966
Phone (305) 860-4660

Other identifiers 1

IdentifierTypeStateIssuer
060942100MedicaidFL

Other names 1

  • Mercy Outpatient Center Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 73

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 73

NPI Registry JSON

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212019200000",
    "number": "1992787576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 331966",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "332331966",
            "telephone_number": "305-860-4660",
            "fax_number": "305-860-4682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3641 S MIAMI AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331334205",
            "telephone_number": "305-860-4660",
            "fax_number": "305-860-4682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY MEDICAL DEVELOPMENT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-18",
        "last_updated": "2008-05-29",
        "status": "A",
        "authorized_official_last_name": "MASHBURN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "305-854-4400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Therapeutic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060942100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Outpatient Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; 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.