NPI Code Detail JSON Logo

1285748285 NPI number — SOUTH DADE PRIMARY CARE, LLC

NPI Number: 1285748285
Health Care Provider/Practitioner: SOUTH DADE PRIMARY CARE, LLC

Information about “1285748285” NPI (SOUTH DADE PRIMARY CARE, LLC) exists in 1285748285 in HTML format HTML  |  1285748285 in plain Text format TXT  |  1285748285 in PDF (Portable Document Format) PDF  |  1285748285 in an XML format XML  formats.

NPI Number : 1285748285 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285748285",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "CLAREMEDICA HEALTH PARTNERS, LLC",
    "ParentOrgTIN": null,
    "OrgName": "SOUTH DADE PRIMARY CARE, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1000 NW 57TH CT STE 400",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIAMI",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33126-3292",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "786-485-1005",
    "MailingAddressFaxNumber": "786-441-2156",
    "FirstLinePracticeLocationAddress": "9835 E HIBISCUS ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PALMETTO BAY",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33157-5406",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "305-238-8561",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/18/2006",
    "LastUpdateDate": "08/27/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "04/26/2023",
    "NPIReactivationDate": "05/10/2023",
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MULLINIX",
    "AuthorizedOfficialFirstName": "MARK",
    "AuthorizedOfficialMiddleName": "L",
    "AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "AUTHORIZED OFFICIAL",
    "AuthorizedOfficialTelephoneNumber": "786-758-3135",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "ME0027176",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "ME0092409",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "ME0016658",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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