| 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 | Vincent Carrodeguas (CEO) |
| Authorized Official Contact | 3053986100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Banyan Community Health Center, Inc 6100 Blue Lagoon Dr Suite 400 Miami FL 33126-2079 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 | 04/18/2022 |
| Certification Date | 04/18/2022 |
| Medicare PECOS PAC ID | 0547410011 |
|---|---|
| Medicare Enrollment ID | O20121017000910 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104247188 | NPI | - | NPPES |
| 013881900 | Medicaid | FL | |
| 013881911 | Medicaid | FL | |
| 013881901 | 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 | Ramses Vega |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760429716 PECOS PAC ID: 8729986278 Enrollment ID: I20031222000726 |
| Provider Name | Ignacio Bobes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902831605 PECOS PAC ID: 0042207326 Enrollment ID: I20040505000831 |
| Provider Name | Saleh Hernandez Cassis |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1114020534 PECOS PAC ID: 9133196314 Enrollment ID: I20040916000241 |
| Provider Name | Alejandro M Urrutia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497930424 PECOS PAC ID: 9931176054 Enrollment ID: I20040916000643 |
| Provider Name | Priscilla M Borrego |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346231768 PECOS PAC ID: 0547229882 Enrollment ID: I20041004000598 |
| Provider Name | Maria A Gorelick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922099290 PECOS PAC ID: 4688633936 Enrollment ID: I20041004000928 |
| Provider Name | Daniel F Mandri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013966704 PECOS PAC ID: 5991755316 Enrollment ID: I20050124000937 |
| Provider Name | Alba M Abreu Naveira |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023166113 PECOS PAC ID: 5193745545 Enrollment ID: I20051130000183 |
| Provider Name | Edmundo Castillo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578654497 PECOS PAC ID: 1759460074 Enrollment ID: I20080512000210 |
| Provider Name | Melba M Roa |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1831148279 PECOS PAC ID: 6002963550 Enrollment ID: I20090420000624 |
| 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 | Francisco Solis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922359991 PECOS PAC ID: 8527213883 Enrollment ID: I20130313000128 |
| Provider Name | Ariel Cagigas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255754552 PECOS PAC ID: 4284531641 Enrollment ID: I20140514001953 |
| Provider Name | Xiomara Sampedro |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1134540297 PECOS PAC ID: 7214250091 Enrollment ID: I20141231000960 |
| Provider Name | Daniela A Ibarra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457750028 PECOS PAC ID: 1557687472 Enrollment ID: I20150311001425 |
| Provider Name | Sandra J Fujita |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437160280 PECOS PAC ID: 6800115684 Enrollment ID: I20150428002190 |
| Provider Name | Patricia Gomez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1427316181 PECOS PAC ID: 4880992999 Enrollment ID: I20160405002590 |
| Provider Name | Christina I Arango |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720469737 PECOS PAC ID: 6002105749 Enrollment ID: I20160518002707 |
| Provider Name | Ruben Bembibre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689962672 PECOS PAC ID: 7911206479 Enrollment ID: I20160527000388 |
| Provider Name | Cynthia Wright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053607069 PECOS PAC ID: 8820355357 Enrollment ID: I20171207002768 |
| Provider Name | Lori Diana Mestre |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235423294 PECOS PAC ID: 2769733427 Enrollment ID: I20180920000026 |
| Provider Name | Laura Beatriz Varela |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457717241 PECOS PAC ID: 0648515569 Enrollment ID: I20181221000923 |
| Provider Name | Paul C. Tretbar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053439638 PECOS PAC ID: 9133466873 Enrollment ID: I20190204000622 |
| Provider Name | Martin Gonzalo Lopez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821589003 PECOS PAC ID: 2062751548 Enrollment ID: I20190227002050 |
| Provider Name | Luis Alexander Dabul |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598127086 PECOS PAC ID: 4981990330 Enrollment ID: I20190321002137 |
| Provider Name | Dinorah Rodriguez Regalado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912485822 PECOS PAC ID: 2163763442 Enrollment ID: I20190415002009 |
| Provider Name | Naomi Auerbach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376076125 PECOS PAC ID: 2668713710 Enrollment ID: I20190418000238 |
| Provider Name | Abdy Pacheco |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447785589 PECOS PAC ID: 8628311446 Enrollment ID: I20190520000856 |
| Provider Name | Annette Marie Naranjo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063625408 PECOS PAC ID: 1254664709 Enrollment ID: I20190614002054 |
| Provider Name | Megan Betancourt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104203355 PECOS PAC ID: 1052647146 Enrollment ID: I20190726002397 |
| Provider Name | Monica Beth Gallino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881843217 PECOS PAC ID: 3173851078 Enrollment ID: I20190829001918 |
| Provider Name | Yeska M Aguilar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528524477 PECOS PAC ID: 7517297898 Enrollment ID: I20190930002303 |
| Provider Name | Shadia Cardoso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063983773 PECOS PAC ID: 4587996798 Enrollment ID: I20191021002282 |
| Provider Name | Aida Franco Julian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275571739 PECOS PAC ID: 7113029364 Enrollment ID: I20191114001403 |
| Provider Name | Milena Sparaga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215594726 PECOS PAC ID: 8325472152 Enrollment ID: I20200102001110 |
| Provider Name | Deina Rae Stevenson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356882609 PECOS PAC ID: 1355777665 Enrollment ID: I20200205001383 |
| Provider Name | Adianez Albelo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811336118 PECOS PAC ID: 7911131586 Enrollment ID: I20200220001934 |
| Provider Name | Jacquelin Da Hora |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992298202 PECOS PAC ID: 2466880885 Enrollment ID: I20200319000014 |
| Provider Name | Cinthya Cabrera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427667963 PECOS PAC ID: 2163849829 Enrollment ID: I20200827000063 |
| 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 | Michell Fuentes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548852494 PECOS PAC ID: 9133534365 Enrollment ID: I20210219001201 |
| Provider Name | Junior Mora-hammer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558942870 PECOS PAC ID: 9537577861 Enrollment ID: I20210426001386 |
| Provider Name | Elizabeth Vah |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265786404 PECOS PAC ID: 9436575735 Enrollment ID: I20210726002945 |
| Provider Name | Layla Cavitt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356871974 PECOS PAC ID: 1153693858 Enrollment ID: I20210728002100 |
| Provider Name | Andrea Horwitz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982000980 PECOS PAC ID: 1658777123 Enrollment ID: I20210908002815 |
| Provider Name | Nadia Deborah Taylor |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1689774382 PECOS PAC ID: 6406900125 Enrollment ID: I20211012001355 |
| Provider Name | Joyce Lynch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164031589 PECOS PAC ID: 6608265897 Enrollment ID: I20211109002112 |
| Provider Name | Tiara Lee Leavitt- Celestina |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396240826 PECOS PAC ID: 6204225907 Enrollment ID: I20211118002244 |
| 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 | Marcos Jose Carvajal Bermejo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578223590 PECOS PAC ID: 5193118966 Enrollment ID: I20220201000207 |
| Provider Name | Alena Diaz De La Nuez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982002705 PECOS PAC ID: 2264826759 Enrollment ID: I20220226000109 |
| Provider Name | Ali-reza Force |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487041752 PECOS PAC ID: 2567782055 Enrollment ID: I20220412002648 |
| Provider Name | Yazmin Pena |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659773091 PECOS PAC ID: 0941532394 Enrollment ID: I20220517003230 |
| Provider Name | Maria Romero-ramos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508902776 PECOS PAC ID: 6103195243 Enrollment ID: I20220711001797 |
| 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 | Kettia Duperval |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164733895 PECOS PAC ID: 5991161010 Enrollment ID: I20230516002002 |
| Provider Name | Evelyn N Franco |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609327824 PECOS PAC ID: 4880046085 Enrollment ID: I20240123002391 |
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