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PROVIDA MEDICAL CENTER INC
NPI 1821928847
Internal Medicine - Geriatric Medicine in North Miami, FL

Active since May 21, 2026CLIA 10D2347324 · Waiver
428 NE 125TH ST, NORTH MIAMI, FL 33161(305) 602-5372 Get Directions Write a Review

NPPES record last updated: May 21, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Provida Medical Center Inc NPPES

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

PROVIDA MEDICAL CENTER INC (NPI 1821928847) is a healthcare organization registered as a geriatric medicine in North Miami, Florida and active in the NPI registry since May 2026. The organization holds a CLIA Waiver certificate valid through July 15, 2028 and lists Mario Sepulveda, Owner, as its authorized official.

NPPES Registry Identity

NPI1821928847
Entity TypeOrganization
Primary Taxonomy207RG0300X
Legal Business NamePROVIDA MEDICAL CENTER INC
Location Address428 NE 125TH STNorth Miami, FL 33161-4717
Mailing Address428 Ne 125th StNorth Miami, FL 33161-4717 · (305) 602-5372
Phone(305) 602-5372
Organization SubpartNo
Authorized OfficialMario SepulvedaOwner · (305) 602-5372
Enumeration DateMay 21, 2026
NPPES CertifiedMay 21, 2026
✔ NPI 1821928847 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Geriatric MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207RG0300X
Definition
An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital.
428 NE 125TH ST, North Miami, FL 33161
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE 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)

Provida Medical Center Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Provida Medical Center Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Juan Perez Sanchez
Nurse Practitioner
NPI 1730857723
925 NE 30TH TER STE 202
Homestead, FL 33033
(305) 246-1030
✔ PECOS32 mi

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2347324

Provida Medical Center, Inc · North Miami, FL
Active · expires Jul 15, 2028
CLIA Number10D2347324
Laboratory TypePhysician Office
Certificate Effective DateJuly 16, 2026
Certificate Expiration DateJuly 15, 2028
Laboratory DirectorEdangel G. Chirino
Laboratory Phone(305) 602-5372
Laboratory LocationProvida Medical Center, Inc428 NE 125th Street, North Miami, FL 33161
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Provida Medical Center Inc's NPI number?

The NPI number for Provida Medical Center Inc is 1821928847. It was assigned to this organization in the NPPES registry on May 21, 2026.

Where is Provida Medical Center Inc located?

Provida Medical Center Inc is located at 428 NE 125th St, North Miami, FL 33161. The listed phone number is (305) 602-5372.

What is Provida Medical Center Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Geriatric Medicine, with taxonomy code 207RG0300X.

Is Provida Medical Center Inc enrolled in Medicare?

Yes. Provida Medical Center Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Provida Medical Center Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Provida Medical Center Inc. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Provida Medical Center Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2347324) is associated with this NPI, valid through July 15, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Provida Medical Center Inc was last updated on May 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.