Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/21/2025 12:16 PM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 105384100 | 2/21/2025 12:16 PM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | FL | 2/21/2025 12:16 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/21/2025 12:16 PM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 026581100 | 2/21/2025 12:16 PM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | FL | 2/21/2025 12:16 PM |
Details | Last Recertification Date | Update | Recertification | 2/8/2024 10:29:26 AM | 2/21/2025 12:16:45 PM | 2/21/2025 12:16 PM |
Details | Last Recertification Date | Update | Recertification | 2/17/2023 10:19:13 AM | 2/8/2024 10:29:26 AM | 2/8/2024 10:29 AM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1215002571 | 11/14/2023 12:03 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | FL | 11/14/2023 12:03 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1689749269 | 11/14/2023 12:03 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | FL | 11/14/2023 12:03 PM |
Details | Last Recertification Date | Update | Recertification | 2/7/2022 3:28:32 PM | 2/17/2023 10:19:13 AM | 2/17/2023 10:19 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/7/2022 3:28 PM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 004242000 | 2/7/2022 3:28 PM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | FL | 2/7/2022 3:28 PM |
Details | Last Recertification Date | Update | Recertification | 2/5/2021 5:20:47 PM | 2/7/2022 3:28:32 PM | 2/7/2022 3:28 PM |
Contacts | Authorizing Official | Update | AO Change Request | Rabinowitz, Mark
CEO
Miami Beach Community Health Center
3055388835-1600 | Menjivar, Sorangely
Chief Operating Officer
Miami Beach Community Health Center
3055388835-1409 | 1/28/2022 8:59 AM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1063411874 | 10/28/2021 12:06 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | FL | 10/28/2021 12:06 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1790081297 | 10/28/2021 12:06 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | FL | 10/28/2021 12:06 PM |
Addresses | Billing Address | Update | Recertification | Miami Beach Community Health Center, Inc.
11645 Biscayne Boulevard,
Suite 207
Miami, FL 33181-3138 | Miami Beach Community Health Center, Inc.
11645 Biscayne Boulevard,
Suite 207
Miami, FL 33181 | 2/5/2021 5:20 PM |
Addresses | Shipping Address | Insert | Recertification | | MIAMI BEACH COMMUNITY HEALTH CENTER PHARMACY #4
11645 BISCAYNE BLVD SUITE # 102
MIAMI, FL 33181 | 2/5/2021 5:20 PM |
Addresses | Main Address | Update | Recertification |
11645 Biscayne Boulevard Suites 103 and 104
Miami, FL 33181-3138 |
11645 Biscayne Boulevard Suites 103 and 104
Miami, FL 33181 | 2/5/2021 5:20 PM |
Medicaid Billing | NPI: State | Update | Recertification | | FL | 2/5/2021 5:20 PM |
Details | Last Recertification Date | Update | Recertification | 1/31/2020 4:16:28 PM | 2/5/2021 5:20:47 PM | 2/5/2021 5:20 PM |
Contacts | Primary Contact | Update | Profile Change Request | Sawaged, Ray
VP Pharmacy Services
Miami Beach Community Health Center, Inc.
3055388835-1602 | Sawaged, Ray
VP Pharmacy Services
Miami Beach Community Health Center, Inc.
3055388835-1585 | 2/3/2021 12:51 PM |
Details | Last Recertification Date | Update | Recertification | 2/4/2019 11:59:20 AM | 1/31/2020 4:16:28 PM | 1/31/2020 4:16 PM |
Addresses | Billing Address | Insert | Recertification | | Miami Beach Community Health Center, Inc.
11645 Biscayne Boulevard,
Suite 207
Miami, FL 33181-3138 | 2/4/2019 11:59 AM |
Details | Last Recertification Date | Update | Recertification | 2/9/2018 11:34:47 AM | 2/4/2019 11:59:20 AM | 2/4/2019 11:59 AM |
Contacts | Primary Contact | Update | Profile Change Request | Sawaged, Ray
VP Pharmacy Services
Miami Beach Community Health Center, Inc.
3055388835-1332 | Sawaged, Ray
VP Pharmacy Services
Miami Beach Community Health Center, Inc.
3055388835-1602 | 2/4/2019 10:31 AM |
Details | Last Recertification Date | Update | Recertification | 2/7/2017 12:00:00 AM | 2/9/2018 11:34:47 AM | 2/9/2018 11:34 AM |
Contacts | Authorizing Official | Update | | Rabinowitz, Mark
CEO
3055388835-1600 | Rabinowitz, Mark
CEO
Miami Beach Community Health Center
3055388835-1600 | 1/8/2018 5:16 PM |
Contacts | Primary Contact | Update | | Sawaged, Ray
VP Pharmacy Services
3055388835-1332 | Sawaged, Ray
VP Pharmacy Services
Miami Beach Community Health Center, Inc.
3055388835-1332 | 10/2/2017 11:31 AM |
Contacts | Primary Contact | Insert | | | Sawaged, Ray
VP Pharmacy Services
3055388835-1332 | 6/29/2017 7:39 PM |
Addresses | Main Address | Insert | | |
11645 Biscayne Boulevard Suites 103 and 104
Miami, FL 33181-3138 | 6/29/2017 7:36 PM |
Contacts | Authorizing Official | Insert | | | Rabinowitz, Mark
CEO
3055388835-1600 | 6/29/2017 7:36 PM |
Medicaid Billing | Medicaid: Number | Update | | 004242000 | 029544207 | 4/10/2017 10:02 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 4/10/2017 10:02 AM |
Medicaid Billing | Medicaid: Number | Insert | | | 029544208 | 4/10/2017 10:02 AM |
Medicaid Billing | Medicaid: State | Insert | | | FL | 4/10/2017 10:02 AM |
Medicaid Billing | NPI: Number | Update | | 1790081297 | 1467606681 | 4/10/2017 10:02 AM |
Details | Entity Subname | Update | | Miami Beach Community Health Center North | MBCHC North Suite 103 & 104 | 4/10/2017 10:02 AM |
Details | Last Recertification Date | Update | | 2/12/2016 12:00:00 AM | 2/7/2017 12:00:00 AM | 2/7/2017 10:04 AM |
Details | Last Recertification Date | Update | | 2/3/2015 12:00:00 AM | 2/12/2016 12:00:00 AM | 2/12/2016 4:40 PM |
Details | Last Recertification Date | Update | | 2/10/2014 12:00:00 AM | 2/3/2015 12:00:00 AM | 2/3/2015 12:52 PM |
Details | Entity Name | Update | | MIAMI BEACH COMMUNITY HEALTH CENTER, INC. | MIAMI BEACH COMMUNITY HEALTH CENTER INC. | 3/31/2014 4:25 PM |
Details | Entity Subname | Update | | | Miami Beach Community Health Center North | 3/31/2014 4:25 PM |
Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 2/10/2014 12:00:00 AM | 2/10/2014 4:43 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 3/19/2013 2:46 PM |
Medicaid Billing | Medicaid: Number | Insert | | | 004242000 | 3/19/2013 2:46 PM |
Medicaid Billing | Medicaid: State | Insert | | | FL | 3/19/2013 2:46 PM |
Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/25/2013 10:10 AM |
Details | Last Recertification Date | Insert | | | | 5/19/2011 1:09 PM |
Details | Grant Number | Insert | | | H80CS00182 | 5/19/2011 1:09 PM |
Details | 340B ID | Insert | | | CH04413A | 5/19/2011 1:09 PM |
Details | Is Authorizing Official EHB Data | Insert | | | | 5/19/2011 1:09 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 5/19/2011 1:09 PM |
Details | Medicare Provider Number | Insert | | | | 5/19/2011 1:09 PM |
Details | Entity Name | Insert | | | MIAMI BEACH COMMUNITY HEALTH CENTER, INC. | 5/19/2011 1:09 PM |
Details | Program Code | Insert | | | CH | 5/19/2011 1:09 PM |
Details | Entity Subname | Insert | | | | 5/19/2011 1:09 PM |
Dates | Participating Approval Date | Insert | | | 6/5/2008 12:00:00 AM | 5/19/2011 1:09 PM |
Details | State | Insert | | | Active | 5/19/2011 1:09 PM |
Dates | Registration Date | Insert | | | 6/4/2008 12:00:00 AM | 5/19/2011 1:09 PM |
Dates | Signed By Date | Insert | | | 4/21/2008 12:00:00 AM | 5/19/2011 1:09 PM |
Dates | Start Date | Insert | | | 7/1/2008 12:00:00 AM | 5/19/2011 1:09 PM |
Terminations | Termination Comments | Insert | | | | 5/19/2011 1:09 PM |
Terminations | Termination Date | Insert | | | | 5/19/2011 1:09 PM |
Terminations | Termination Effective Date | Insert | | | | 5/19/2011 1:09 PM |
Terminations | Termination Reason | Insert | | | | 5/19/2011 1:09 PM |
Details | Comments Public | Insert | | | 5/19/11 REMOVED SUB DIV NAME (WAS ADMIN OFFICE); 5/3/11 UPDATED PHYS ADD (WAS SUITE #207) | 5/19/2011 1:09 PM |
Medicaid Billing | NPI: Number | Insert | | | 1790081297 | 6/4/2008 1:54 PM |