PEDIATRIC SPECIALTY GROUP, INC. (NPI# 1063966901) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063966901 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC SPECIALTY GROUP, INC. |
| Other Organization Name | PEDIATRIC SPECIALISTS OF AMERICA- RADIOLOGY |
| Practice Address |
3100 Sw 62nd Ave 1st Floor, Suite B- Department of Radiology Miami FL 33155 |
| Mailing Address |
Po Box 865095 Orlando FL 32886-5095 |
| Practice Telephone | 7866245876 |
| Practice Fax Number | 7866242688 |
| Mailing Telephone | 7866245876 |
| Mailing Fax Number | 7866242688 |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2018-06-15 |
| Authorized Official Name | ELIZABETH MENOCAL (AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 3056628357 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085P0229X |
Radiology Specialization: Pediatric Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 013515214 | 05 |
| Other Name | Type Code |
|---|---|
| Pediatric Specialists of America- Radiology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316589914 | Pediatric Specialty Group, Inc. | Pediatrics | 9750 Nw 33rd St Ste 109, Coral Springs, FL 33065-4000 | 2019-10-15 |
| 1457965345 | Pediatric Specialty Group, Inc. | Pediatrics | 3100 Sw 62nd Ave, Miami, FL 33155-3009 | 2020-09-08 |
| 1306459177 | Pediatric Specialty Group, Inc. | Pediatrics | 3100 Sw 62nd Ave, Miami, FL 33155-3009 | 2020-08-31 |
| 1235774852 | Pediatric Specialty Group, Inc. | Pediatrics | 3100 Sw 62nd Ave, 1st Floor, Trauma Unit, Miami, FL 33155-3009 | 2019-11-07 |
| 1124553656 | Pediatric Specialty Group, Inc. | Pediatrics | 3100 Sw 62nd Ave, Apcp- 6 Tower, Suite 6226, Miami, FL 33155-3009 | 2017-04-21 |
| 1881128171 | Pediatric Specialty Group, Inc. | Pediatrics | 3100 Sw 62nd Ave, Palliative Care Medicine- 3rd Floor- Suite 6-74, Miami, FL 33155 | 2017-04-13 |
| 1194277756 | Pediatric Specialty Group, Inc. | Psychologist | 3100 Sw 62nd Ave, Department of Psychology, Miami, FL 33155-3009 | 2016-10-31 |
| 1528512001 | Pediatric Specialty Group, Inc. | Pediatrics | 3100 Sw 62nd Ave, Department of Gastroenterology, Miami, FL 33155 | 2016-08-12 |
| 1891249371 | Pediatric Specialty Group, Inc. | Pediatrics | 3100 Sw 62nd Ave Ste 102, Miami, FL 33155 | 2016-08-12 |
| 1982158820 | Pediatric Specialty Group, Inc. | Ophthalmology | 3100 Sw 62nd Ave, Miami, FL 33155 | 2016-08-09 |
| Street Address |
3100 SW 62ND AVE 1ST FLOOR, SUITE B- DEPARTMENT OF RADIOLOGY |
| City | MIAMI |
| State | FL |
| Zip Code | 33155 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104824077 | Rene Luis Lopez-guerrero | Pediatrics | 3100 Sw 62nd Ave, Miami, FL 33155-3009 | 2005-07-13 |
| 1598366239 | Alejandra Margarita Patterson | Registered Nurse | 3100 Sw 62nd Ave, Suite 108 Center for Spinal Disorders, Miami, FL 33155 | 2020-11-07 |
| 1093315947 | Mailys Santoro | Nurse Practitioner | 3100 Sw 62nd Ave, Miami, FL 33155-3009 | 2020-10-29 |
| 1174121289 | Lilia M Mendoza | Family Medicine | 3100 Sw 62nd Ave, Miami, FL 33155-3009 | 2020-10-12 |
| 1932707007 | Brian Ruiz | Nurse Practitioner | 3100 Sw 62nd Ave, Miami, FL 33155-3009 | 2020-10-12 |
| 1457965345 | Pediatric Specialty Group, Inc. | Pediatrics | 3100 Sw 62nd Ave, Miami, FL 33155-3009 | 2020-09-08 |
| 1306459177 | Pediatric Specialty Group, Inc. | Pediatrics | 3100 Sw 62nd Ave, Miami, FL 33155-3009 | 2020-08-31 |
| 1568075372 | Nancy Pierre | Nurse Practitioner | 3100 Sw 62nd Ave, Miami, FL 33155-3009 | 2020-08-31 |
| 1841803335 | Dicle Yasar Aksoyler | Student in an Organized Health Care Education/Training Program | 3100 Sw 62nd Ave, Miami, FL 33155-3009 | 2020-08-25 |
| 1154932952 | Veronica A Quintanar Sanabria | Nurse Practitioner | 3100 Sw 62nd Ave, Miami, FL 33155-3009 | 2020-08-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659987121 | Blanca Argentina Torres | Speech-Language Pathologist | 6840 Bird Rd Unit 211a, Miami, FL 33155 | 2020-09-21 |
| 1245888585 | Mila De La Caridad Broche Coego | Behavior Technician | 2247 Sw 68th Ct, Miami, FL 33155 | 2019-08-29 |
| 1265087878 | Nancy Acela Denis | Nurse Practitioner | 6791 Sw 25 Terra, Miami, FL 33155 | 2019-08-09 |
| 1700366887 | Aly Hashim | Family Medicine | 2805 Sw 75th Avenue, Miami, FL 33155 | 2018-08-17 |
| 1184115362 | Ready 2 Transfer, Inc. | Non-emergency Medical Transport (VAN) | 7811 Sw 24 Street #120, Miami, FL 33155 | 2018-05-23 |
| 1053808030 | Idalmis Pimentel Diez | Behavior Technician | 6334 Sw 30th St, Miami, FL 33155 | 2018-04-16 |
| 1225538689 | L & L Social Services LLC | Case Management | 5950 Sw 40 St, Miami, FL 33155 | 2018-02-12 |
| 1659888915 | Red Bird Dental Care | Dentist | 5771 Sw 40 St, Miami, FL 33155 | 2018-01-08 |
| 1043726474 | Jesenia Rodriguez-vila | Nurse Practitioner | 6433 Sw 29th St, Miami, FL 33155 | 2017-12-21 |
| 1326553736 | Believe Neuro-behavioral Services | Behavioral Analyst | 6700 Sw 38th St, Miami, FL 33155 | 2017-12-07 |
| Find all providers in zip 33155 | ||||
| Taxonomy Code | 2085P0229X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Pediatric Radiology |
| A radiologist who is proficient in all forms of diagnostic imaging as it pertains to the treatment of diseases in the newborn, infant, child and adolescent. This specialist has knowledge of both imaging and interventional procedures related to the care and management of diseases of children. A pediatric radiologist must be highly knowledgeable of all organ systems as they relate to growth and development, congenital malformations, diseases peculiar to infants and children and diseases that begin in childhood but cause substantial residual impairment in adulthood. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467794305 | Julio Daniel Egusquiza | Radiology | 3100 Sw 62nd Ave, Miami, FL 33155-3009 | 2013-03-18 |
| 1679846935 | Variety Children's Hospital | Radiology | 3915 Biscayne Blvd, Miami, FL 33137-3779 | 2012-02-17 |
| 1265728935 | Rachel Pevsner Crum | Radiology | 3100 Sw 62nd Ave, Miami, FL 33155-3009 | 2011-06-21 |
| 1285945493 | Mch Pediatric Cardiology, LLC | Radiology | 13400 Sw 120th St, Suite 200, Miami, FL 33186-7440 | 2010-06-23 |
| 1861625378 | Maria D'almeida Bastos | Radiology | 1611 Nw 12th Ave, West Wing 279, Miami, FL 33136-1005 | 2009-08-31 |
| 1891926333 | Enrique Alvarado Burgos | Radiology | 3100 Sw 62nd Ave, Miami, FL 33155 | 2009-07-31 |
| 1871736975 | Variety Childern's Hospital | Radiology | 13400 Sw 120th St, Suite 100 & 200, Miami, FL 33186-7440 | 2009-04-20 |
| 1104012715 | Philip Teitelbaum | Radiology | 8900 N. Kendall Drive, Children's Hospital Boston, Miami, FL 33176-2118 | 2007-09-18 |
| 1346447786 | Aaron D Nordgren | Radiology | 8900 N Kendall Dr, Miami, FL 33176 | 2007-06-29 |
| 1205987120 | Gisela Henriquez | Radiology | 1150 Nw 14th St, Suite 407, Miami, FL 33136-2137 | 2007-01-16 |
| Find all providers in MIAMI | ||||
Please comment or provide details below to improve the information on PEDIATRIC SPECIALTY GROUP, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.