NPIMap

Organization Active NPI

Community Health of South Florida Inc

  • Federally Qualified Health Center (FQHC)
  • Homestead, FL
National Provider Identifier
1992968408
Registry record updated Apr 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH OF SOUTH FLORIDA INC
Practice address
15790 SW 307TH St
Homestead, FL 33033-4200
Phone
(305) 245-0270
Fax
(305) 247-7903
NPI assigned
Jul 3, 2008
Last updated
Apr 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2013

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

Authorized official

Name
Brodes H Hartley Jr.
Title
Ceo
Phone
(305) 253-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

15790 SW 307TH St
Homestead, FL 33033-4200

Mailing address

10300 SW 216TH St
Miami, FL 33190-1003
Phone (305) 253-5100

Other names 1

  • Campbell Drive Elementary Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040719001329 FL Part A Provider - Federally Qualified Health Center (FQHC) 6507770526 Practice locations: Homestead, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992968408. Details of each certification follow.

Federally qualified health center certification: CCN 101961

Legal name
COMMUNITY HEALTH OF SOUTH FLORIDA INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 10, 2004
Last certification
Aug 10, 2004
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 13, 1971 in FL
Enrollment address
15790 SW 307TH Street
Homestead, FL 33030-4200

Other NPIs with the same Medicare PAC ID 17

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Community Health Inc57 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

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

Locations

15790 SW 307th St
Homestead, FL 33033
Phone (305) 245-0270

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Cesar Caicedo Individual Corporate DirectorBoard of Directors Jan 1, 2015
Natalie Windsor Individual Corporate DirectorBoard of Directors Jan 1, 2022
Paul Herdsman Individual Corporate DirectorBoard of Directors Jan 1, 2022
Jeremy Radziewicz Individual Corporate DirectorCfo Aug 6, 2019
Jeffrey Coldren Individual Corporate DirectorBoard of Directors Jan 1, 2015
Andre Reid Individual Corporate DirectorBaord of Directors Jan 1, 2022
Jose Gancedo Individual Corporate DirectorBoard of Directors Jan 1, 2022
Carolyn Taylor-Pates Individual Corporate DirectorBoard of Directors Jan 1, 2008
Johnny Brown Individual Corporate DirectorBoard of Directors Jan 1, 2015
Carlo Saint Cy Individual Corporate DirectorBoard of Directors Jan 1, 2022
Anthony B Hall Individual Corporate DirectorPresident/Ceo Jan 1, 2022
W-2 Managing EmployeePresident/Ceo Jan 1, 2022

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.

NPI Registry JSON

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366156800000",
    "number": "1992968408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10300 SW 216TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331901003",
            "telephone_number": "305-253-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15790 SW 307TH ST",
            "city": "HOMESTEAD",
            "state": "FL",
            "postal_code": "330334200",
            "telephone_number": "305-245-0270",
            "fax_number": "305-247-7903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH OF SOUTH FLORIDA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-03",
        "last_updated": "2013-04-17",
        "status": "A",
        "authorized_official_last_name": "HARTLEY",
        "authorized_official_first_name": "BRODES",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-253-5100",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Campbell Drive Elementary",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Homestead, FL

Sources for this page

Verify at the official NPI Registry.