| Banyan Community Health Center, Inc. | |
|
3733 W Flagler St Coral Gables FL 33134-1601 | |
| (305) 398-6100 | |
| (305) 398-6099 |
| Full Name | Banyan Community Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 3733 W Flagler St, Coral Gables, Florida |
| Authorized Official Name and Position | Manuel Andres Fernandez (CEO) |
| Authorized Official Contact | 5612139211 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Banyan Community Health Center, Inc. 2300 Nw 89th Pl Fl 3 Doral FL 33172-2431 Ph: (305) 398-6100 | Banyan Community Health Center, Inc. 3733 W Flagler St Coral Gables FL 33134-1601 Ph: (305) 398-6100 |
| NPI Number | 1104247188 |
|---|---|
| Provider Enumeration Date | 12/18/2013 |
| Last Update Date | 04/15/2025 |
| Certification Date | 04/15/2025 |
| Medicare PECOS PAC ID | 0547410011 |
|---|---|
| Medicare Enrollment ID | O20121017000910 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104247188 | NPI | - | NPPES |
| 013881901 | Medicaid | FL | |
| 013881911 | Medicaid | FL | |
| 013881900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Priscilla M Borrego |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346231768 PECOS PAC ID: 0547229882 Enrollment ID: I20041004000598 |
| Provider Name | Alba M Abreu Naveira |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023166113 PECOS PAC ID: 5193745545 Enrollment ID: I20051130000183 |
| Provider Name | Edwin A Gomez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780775098 PECOS PAC ID: 4880735406 Enrollment ID: I20100105000354 |
| Provider Name | Mario S Cuervo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578664363 PECOS PAC ID: 5395703185 Enrollment ID: I20100831000800 |
| Provider Name | Manuela Georgescu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912157306 PECOS PAC ID: 6800077710 Enrollment ID: I20110225000400 |
| Provider Name | Antonio Eugenio Tauler |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851342844 PECOS PAC ID: 5092983668 Enrollment ID: I20110726000562 |
| Provider Name | Ariel Cagigas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255754552 PECOS PAC ID: 4284531641 Enrollment ID: I20140514001953 |
| Provider Name | Sandra J Fujita |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437160280 PECOS PAC ID: 6800115684 Enrollment ID: I20150428002190 |
| Provider Name | Linda M Collado |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588958391 PECOS PAC ID: 7517117591 Enrollment ID: I20170725002952 |
| Provider Name | Vicky Marsh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861748717 PECOS PAC ID: 8224396395 Enrollment ID: I20180106000033 |
| Provider Name | Luis Alexander Dabul |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598127086 PECOS PAC ID: 4981990330 Enrollment ID: I20190321002137 |
| Provider Name | Adianez Albelo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811336118 PECOS PAC ID: 7911131586 Enrollment ID: I20200220001934 |
| Provider Name | Melanie Mari Gregory |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639634306 PECOS PAC ID: 6305266511 Enrollment ID: I20201008002541 |
| Provider Name | Eduardo Miguel Padilla Berdugo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972110765 PECOS PAC ID: 0244643559 Enrollment ID: I20210106000239 |
| Provider Name | Andrea Horwitz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982000980 PECOS PAC ID: 1658777123 Enrollment ID: I20210908002815 |
| Provider Name | Jordan Michael Guedes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447882394 PECOS PAC ID: 5193117711 Enrollment ID: I20220111002178 |
| Provider Name | Yannier Ferrer Martinez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962909358 PECOS PAC ID: 1850772260 Enrollment ID: I20220718000115 |
| Provider Name | Andres Felipe Pareja |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326744079 PECOS PAC ID: 8921473828 Enrollment ID: I20230406001149 |
| Provider Name | Hercule Lamur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386109692 PECOS PAC ID: 5698136182 Enrollment ID: I20230816000870 |
| Provider Name | Natalie Kutlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174139513 PECOS PAC ID: 1254787963 Enrollment ID: I20231031002712 |
| Provider Name | Brittany Aisha Ajegba |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508493131 PECOS PAC ID: 4688025000 Enrollment ID: I20240110003446 |
| Provider Name | Priscilla Mercy Juncadella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780469759 PECOS PAC ID: 9234581000 Enrollment ID: I20240117001762 |
| Provider Name | Evelyn N Franco |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609327824 PECOS PAC ID: 4880046085 Enrollment ID: I20240123002391 |
| Provider Name | Alan Paul Kuppers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114978491 PECOS PAC ID: 1759733983 Enrollment ID: I20240123003711 |
| Provider Name | Allycia Nicole Crawford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992257968 PECOS PAC ID: 9234469628 Enrollment ID: I20240410003962 |
| Provider Name | Mario Perez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427084359 PECOS PAC ID: 6305284274 Enrollment ID: I20240411000228 |
| Provider Name | Jaimee Hinkes Montalvo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538383302 PECOS PAC ID: 3173050259 Enrollment ID: I20241231003451 |
| Provider Name | Evelyn C Alvino |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225085863 PECOS PAC ID: 8022545094 Enrollment ID: I20250102003440 |
| Provider Name | Samantha Eve Morris |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1922464007 PECOS PAC ID: 5799213906 Enrollment ID: I20250115000953 |
| Provider Name | Izza Marie Alcaide |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740695584 PECOS PAC ID: 6901335702 Enrollment ID: I20250123001842 |
| Provider Name | Michelle J Aguilera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952949455 PECOS PAC ID: 2567992563 Enrollment ID: I20250205003705 |
| Provider Name | Liliam R. Machado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972168227 PECOS PAC ID: 8820528680 Enrollment ID: I20250207003001 |
| Provider Name | Jacnery Rodriguez Perez |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1477377422 PECOS PAC ID: 1254861842 Enrollment ID: I20250212000990 |
| Provider Name | Shoshana Dahan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386186765 PECOS PAC ID: 0547780975 Enrollment ID: I20250227003862 |
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