OrganizationActive
Med-Source Group LLC.
NPI 1114304144 · Point of Service · Miami Lakes, FL
Provider details
- NPI number
- 1114304144
- Entity type
- Organization
- Primary specialty
- Point of ServiceManaged Care Organizations
- Organization subpart
- No
- Authorized official
- Otto Valdes, Ceo(786) 443-0873
Specialties & taxonomies
Managed Care Organizations
Profile Score
Established profile(74/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
15476 Nw 77th Ct
Miami Lakes, FL 33016-5823
Phone: (786) 443-0873
Street-level locationGet directions
Mailing address
15476 Nw 77th Ct
Miami Lakes, FL 33016-5823
Registry dates
- Enumerated
- 2015-04-28
- Last updated
- 2015-04-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.