Memorial Division of Complex Pediatric Gastroenterology – Pediatric Gastroenterology Physician, NPI 1528659679
Pediatric Gastroenterology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Memorial Division of Complex Pediatric Gastroenterology
2900 CORPORATE WAY
DOOR D
MIRAMAR, FL 330253925
Phone: (954) 276-5685
Type: Mailing
1150 N 35th Ave Ste 490
Hollywood, FL 330215423
Phone: (954) 265-3437
Fax: (954) 983-5052
Type: Location
3377 S State Road 7 Ste 100
Wellington, FL 334498002
Phone: (954) 265-4475
Fax: (954) 276-0754
Type: Location
1971 SW 172nd Ave Ste 2500
Miramar, FL 330295621
Phone: (954) 265-4475
Fax: (954) 276-0754
Type: Location
900 Glades Rd Ste 501
Boca Raton, FL 334316421
Phone: (954) 265-4475
Fax: (954) 276-0754
Type: Location
1131 N 35th Ave Ste 330
Hollywood, FL 330215403
Phone: (954) 265-4475
Fax: (954) 276-0754
Type: Location
1131 N 35TH AVE STE 300
HOLLYWOOD, FL 330215403
Phone: (954) 265-4475
Fax: (954) 276-0754
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: 2021-03-09
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation scheduled
Earliest CMS due date is 2026-09-30 (112 days away).
Enrollment records
1
Earliest due date
2026-09-30
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 |
|---|---|---|---|---|
| O20210309000237 | O | Clinic/Group Practice | FL | 2026-09-30 |
What to do next
- Monitor the published due date as it approaches.
- Plan to revalidate in PECOS within the window CMS allows before the due date.
- Verify the date on the CMS Revalidation Lookup Tool before submitting.
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 33025)
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