Memorial Division of Pediatric General Surgery – Pediatric Surgery Physician, NPI 1306177589
Pediatric Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Memorial Division of Pediatric General Surgery
20803 Biscayne Blvd Ste 204-A
Aventura, FL 331801469
Phone: (954) 265-0072
Fax: (954) 981-0188
Type: Location
5830 Coral Ridge Dr Ste 140
Coral Springs, FL 330763388
Phone: (954) 265-0072
Fax: (954) 981-0188
Type: Location
3377 N State Rd 7 Suite 100
Wellington, FL 334498082
Phone: (954) 265-0072
Fax: (954) 981-0188
Type: Location
1865 N Corporate Lakes Blvd Ste 1
Weston, FL 333263273
Phone: (954) 265-0072
Fax: (954) 981-0188
Type: Location
1971 SW 172nd Ave Ste 2500
Miramar, FL 330295621
Phone: (954) 265-0072
Fax: (954) 981-0188
Type: Location
2900, Corporate Way, Miramar, Broward County, Florida, 33025, United States
DOOR D
MIRAMAR, FL 330253925
Phone: (954) 276-5685
Fax: (954) 985-7074
Type: Mailing
1150, North 35th Avenue, West Hollywood, Hollywood, Broward County, Florida, 33021, United States
SUITE 555
HOLLYWOOD, FL 330215424
Phone: (954) 265-0072
Fax: (954) 981-0188
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: 2016-07-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-07-31 (1044 days ago).
Enrollment records
1
Earliest due date
2023-07-31
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 |
|---|---|---|---|---|
| O20160729001072 | O | Hospital Department(S) | FL | 2023-07-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 33180)
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