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DEDICATED MISSOURI HOLDING, LLC
NPI 1053958082
Internal Medicine in Miami Gardens, FL

Active since December 10, 2019
1395 NW 167TH ST, MIAMI GARDENS, FL 33169(305) 628-6117 Get Directions Write a Review

NPPES record last updated: October 31, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 19, 2024, Dec 10, 2019 (2 updates tracked since 2019).

About Dedicated Missouri Holding, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DEDICATED MISSOURI HOLDING, LLC (NPI 1053958082) is a healthcare organization registered as an internal medicine in Miami Gardens, Florida and active in the NPI registry since December 2019. The organization lists Mary Chen, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1053958082
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameDEDICATED MISSOURI HOLDING, LLC
Location Address1395 NW 167TH STMiami Gardens, FL 33169-5710
Mailing Address1395 Nw 167th StMiami Gardens, FL 33169-5710 · (305) 628-6117
Phone(305) 628-6117
Organization SubpartNo
Authorized OfficialMary ChenAuthorized Official · (305) 831-4722
Enumeration DateDecember 10, 2019
Last NPPES UpdateOctober 31, 20242 updates tracked since enumeration
NPPES CertifiedOctober 31, 2024
✔ NPI 1053958082 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
1395 NW 167TH ST, Miami Gardens, FL 33169
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dedicated Missouri Holding, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

24

Medicare enrollment records show 24 clinicians reassign Medicare billing to Dedicated Missouri Holding, LLC, which bills Medicare for the services they deliver. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 5

Family Practice12
Internal Medicine5
Nurse Practitioner5
Infectious Disease1
Podiatry1

Nearest to this location (20)

See all 24
Susan Schayes, MD
Family Practice
NPI 1720183254
2124 CANDLER RD
Decatur, GA 30032
(404) 836-0272
✔ PECOS590 mi
Latha Cherath, MD
Internal Medicine
NPI 1134446859
5131 QUINCE RD
Memphis, TN 38117
(901) 701-1888
✔ PECOS854 mi
Angie Harris, DO
Family Practice
NPI 1972694685
4600 MEMORIAL DR STE 260
Belleville, IL 62226
(618) 257-4100
✔ PECOS✔ Accepts Medicare1,040 mi
Jason Woody, DO
Family Practice
NPI 1295304103
3721 S GRAND BLVD
Saint Louis, MO 63118
(314) 328-0144
✔ PECOS✔ Accepts Medicare1,050 mi
Andrea Brown, DO
Family Practice
NPI 1548897499
3721 S GRAND BLVD
Saint Louis, MO 63118
(314) 328-0144
✔ PECOS✔ Accepts Medicare1,050 mi
Chia-Yuan Hsu
Internal Medicine
NPI 1154909828
3721 S GRAND BLVD
Saint Louis, MO 63118
(314) 328-0144
✔ PECOS1,050 mi
Jillian Williams, FNP-BC
Nurse Practitioner
NPI 1831719384
3721 S GRAND BLVD
Saint Louis, MO 63118
(314) 328-0144
✔ PECOS1,050 mi
Anne Jacob, M.B.B.S.
Family Practice
NPI 1033107636
3649 PAGE BLVD
Saint Louis, MO 63113
(314) 288-0071
✔ PECOS1,052 mi
Indolfo Luna, DPM
Podiatry
NPI 1629560891
3649 PAGE BLVD
Saint Louis, MO 63113
(314) 288-0071
✔ PECOS1,052 mi
Candias Smith, FNP-APRN
Nurse Practitioner
NPI 1063915015
5471 DR MARTIN LUTHER KING DR
Saint Louis, MO 63112
(314) 367-5820
✔ PECOS1,055 mi
Kunal Gurav, M.D
Internal Medicine
NPI 1033434576
1034 S BRENTWOOD BLVD STE 694
Saint Louis, MO 63117
(314) 557-2620
✔ PECOS✔ Accepts Medicare1,056 mi
Delora Brooks, FNP-BC
Nurse Practitioner
NPI 1659622330
175 N OAKS PLZ
Saint Louis, MO 63121
(314) 391-9777
✔ PECOS✔ Accepts Medicare1,057 mi
Edward Duqum, DO
Internal Medicine
NPI 1487278941
175 N OAKS PLZ
Saint Louis, MO 63121
(314) 391-9777
✔ PECOS✔ Accepts Medicare1,057 mi
La Tanya Lawrence, AS
Nurse Practitioner
NPI 1104121102
175 N OAKS PLZ
Saint Louis, MO 63121
(314) 391-9777
✔ PECOS1,057 mi
Vincent Ngo, M.D.
Family Practice
NPI 1730703117
175 N OAKS PLZ
Saint Louis, MO 63121
(314) 391-9777
✔ PECOS1,057 mi
Salwat Shami, M.D.
Internal Medicine
NPI 1053579094
175 N OAKS PLZ
Saint Louis, MO 63121
(314) 391-9777
✔ PECOS✔ Accepts Medicare1,057 mi
Troy Dowers, M.D.
Family Practice
NPI 1841497716
10990 NEW HALLS FERRY RD STE 1
Saint Louis, MO 63136
(314) 788-6444
✔ PECOS1,060 mi
Frederick Kuhlmann, MD
Infectious Disease
NPI 1417981481
621 S NEW BALLAS RD STE 7018B
Saint Louis, MO 63141
(314) 251-4949
✔ PECOS✔ Accepts Medicare1,061 mi
Rishi Sud, M.D.
Family Practice
NPI 1598749004
977 TARA OAKS DR
Chesterfield, MO 63005
(773) 636-1646
✔ PECOS1,066 mi
Poovizhi Selvi Velmurugan, MSN-NP-C
Nurse Practitioner
NPI 1497340483
4400 E 39TH ST
Kansas City, MO 64128
(816) 791-7177
✔ PECOS✔ Accepts Medicare1,228 mi
See all 24 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dedicated Missouri Holding, LLC's NPI number?

The NPI number for Dedicated Missouri Holding, LLC is 1053958082. It was assigned to this organization in the NPPES registry on December 10, 2019.

Where is Dedicated Missouri Holding, LLC located?

Dedicated Missouri Holding, LLC is located at 1395 NW 167th St, Miami Gardens, FL 33169. The listed phone number is (305) 628-6117.

What is Dedicated Missouri Holding, LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Dedicated Missouri Holding, LLC enrolled in Medicare?

Yes. Dedicated Missouri Holding, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Dedicated Missouri Holding, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 24 clinicians in 5 Medicare specialties reassign their Medicare billing to Dedicated Missouri Holding, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Family Practice (12), Internal Medicine (5) and Nurse Practitioner (5). Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Dedicated Missouri Holding, LLC was last updated on October 31, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.