SOUTH DADE PRIMARY CARE, LLC – Family Medicine Physician, NPI 1285748285
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SOUTH DADE PRIMARY CARE, LLC
1000 NW 57TH CT STE 400
MIAMI, FL 331263292
Phone: (786) 485-1005
Fax: (786) 441-2156
Type: Mailing
12294 Indian Rocks Rd
Largo, FL 337743001
Phone: (727) 595-2534
Type: Location
7108 N Nebraska Ave
Tampa, FL 336044915
Phone: (813) 239-3262
Type: Location
4700 N Habana Ave Ste 403
Tampa, FL 336147119
Phone: (813) 876-9553
Type: Location
8004 N Armenia Ave
Tampa, FL 336042763
Phone: (813) 933-9131
Type: Location
1500 E Hillsboro Blvd Ste 210
Deerfield Beach, FL 334414348
Phone: (954) 419-9632
Type: Location
1190 NW 95th St Ste 310
Miami, FL 331502067
Phone: (305) 835-9844
Type: Location
1806 N Pine Island Rd
Plantation, FL 333225202
Phone: (954) 474-0110
Type: Location
3345 Burns Rd Ste 302
Palm Beach Gardens, FL 334104321
Phone: (561) 622-7661
Type: Location
11211 SW 152nd St
Miami, FL 331571101
Phone: (305) 255-1355
Type: Location
15335 SW 288th St
Homestead, FL 330331356
Phone: (305) 248-3814
Type: Location
9835 E HIBISCUS ST
PALMETTO BAY, FL 331575406
Phone: (305) 238-8561
Type: Location
Northwest 77th Court, Miami Lakes, Miami-Dade County, Florida, 33016, United States
MIAMI LAKES, FL 330161507
Phone: (786) 485-1005
Fax: (786) 441-2156
Type: Mailing
205, 74th Street, Atlantic Heights, Miami Beach, Miami-Dade County, Florida, 33141, United States
MIAMI, FL 331435150
Phone: (305) 666-8691
Fax: (305) 666-6580
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-11-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20051116000041 | O | Clinic/Group Practice | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33126)
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