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  5. SAWGRASS PEDIATRICS, LLC

SAWGRASS PEDIATRICS, LLC

Company Details

Entity Name: SAWGRASS PEDIATRICS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 23 Jul 2004 (21 years ago)
Last Event: CANCEL ADM DISS/REV
Event Date Filed: 05 Oct 2006 (18 years ago)
Document Number: L04000055115
FEI/EIN Number 201415382
Address: 9750 NW 33RD STREET, SUITE 101, CORAL SPRINGS, FL, 33065
Mail Address: 9750 NW 33RD STREET, SUITE 101, CORAL SPRINGS, FL, 33065
ZIP code: 33065
County: Broward
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1275650327 2007-03-23 2008-08-11 9750 NW 33RD ST, SUITE 101, CORAL SPRINGS, FL, 330654042, US 9750 NW 33RD ST, SUITE 101, CORAL SPRINGS, FL, 330654042, US

Contacts
Phone +1 954-752-9220
Fax 9547555025

Authorized person
Name LORNE KATZ
Role PRESIDENT
Phone 9547529220

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 272198800
State FL
Issuer MEDICAID
Number 272198801
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SAWGRASS PEDIATRICS LLC 401(K) PROFIT SHARING PLAN & TRUST 2019 201415382 2020-06-18 SAWGRASS PEDIATRICS LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 9547529220
Plan sponsor’s address 9750 NW 33RD ST STE 101, CORAL SPRINGS, FL, 330654000

Signature of
Role Plan administrator
Date 2020-06-18
Name of individual signing STACEY SINGER
Valid signature Filed with authorized/valid electronic signature
SAWGRASS PEDIATRICS LLC 401 K PROFIT SHARING PLAN TRUST 2017 201415382 2018-07-20 SAWGRASS PEDIATRICS LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 9547529220
Plan sponsor’s address 9750 NW 33RD ST STE 101, CORAL SPRINGS, FL, 330654000

Signature of
Role Plan administrator
Date 2018-07-20
Name of individual signing STACEY SINGER
Valid signature Filed with authorized/valid electronic signature
SAWGRASS PEDIATRICS LLC 401 K PROFIT SHARING PLAN TRUST 2016 201415382 2017-07-31 SAWGRASS PEDIATRICS LLC 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 9547529220
Plan sponsor’s address 9750 NW 33RD ST STE 101, CORAL SPRINGS, FL, 330654000

Signature of
Role Plan administrator
Date 2017-07-31
Name of individual signing LORNE KATZ
Valid signature Filed with authorized/valid electronic signature
SAWGRASS PEDIATRICS LLC 401 K PROFIT SHARING PLAN TRUST 2015 201415382 2016-06-13 SAWGRASS PEDIATRICS LLC 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 9547529220
Plan sponsor’s address 9750 NW 33RD ST STE 101, CORAL SPRINGS, FL, 330654000

Signature of
Role Plan administrator
Date 2016-06-13
Name of individual signing SUSAN WATERS
Valid signature Filed with authorized/valid electronic signature
SAWGRASS PEDIATRICS LLC 401 K PROFIT SHARING PLAN TRUST 2014 201415382 2015-06-08 SAWGRASS PEDIATRICS LLC 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 9547529220
Plan sponsor’s address 9750 NW 33RD ST STE 101, CORAL SPRINGS, FL, 330654000

Signature of
Role Plan administrator
Date 2015-06-08
Name of individual signing STACEY SINGER
Valid signature Filed with authorized/valid electronic signature
SAWGRASS PEDIATRICS LLC 401 K PROFIT SHARING PLAN TRUST 2013 201415382 2014-06-24 SAWGRASS PEDIATRICS LLC 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 9547529220
Plan sponsor’s address 9750 NW 33RD ST STE 101, CORAL SPRINGS, FL, 330654000

Signature of
Role Plan administrator
Date 2014-06-24
Name of individual signing LORNE KATZ, M.D.
Valid signature Filed with authorized/valid electronic signature
SAWGRASS PEDIATRICS LLC 401 K PROFIT SHARING PLAN TRUST 2012 201415382 2013-06-25 SAWGRASS PEDIATRICS LLC 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 9547529220
Plan sponsor’s address 9750 NW 33RD ST STE 101, CORAL SPRINGS, FL, 330654000

Signature of
Role Plan administrator
Date 2013-06-25
Name of individual signing SAWGRASS PEDIATRICS LLC
Valid signature Filed with authorized/valid electronic signature
SAWGRASS PEDIATRICS LLC 401 K PROFIT SHARING PLAN TRUST 2011 201415382 2012-07-11 SAWGRASS PEDIATRICS LLC 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 9547529220
Plan sponsor’s address 9750 NW 33RD ST STE 101, CORAL SPRINGS, FL, 330654000

Plan administrator’s name and address
Administrator’s EIN 201415382
Plan administrator’s name SAWGRASS PEDIATRICS LLC
Plan administrator’s address 9750 NW 33RD ST STE 101, CORAL SPRINGS, FL, 330654000
Administrator’s telephone number 9547529220

Signature of
Role Plan administrator
Date 2012-07-11
Name of individual signing SAWGRASS PEDIATRICS LLC
Valid signature Filed with authorized/valid electronic signature
SAWGRASS PEDIATRICS LLC 401 K PROFIT SHARING PLAN TRUST 2010 201415382 2011-06-29 SAWGRASS PEDIATRICS LLC 31
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 9547529220
Plan sponsor’s address 9750 NW 33RD STREET, SUITE 101, CORAL SPRINGS, FL, 330650000

Plan administrator’s name and address
Administrator’s EIN 201415382
Plan administrator’s name SAWGRASS PEDIATRICS LLC
Plan administrator’s address 9750 NW 33RD STREET, SUITE 101, CORAL SPRINGS, FL, 330650000
Administrator’s telephone number 9547529220

Signature of
Role Plan administrator
Date 2011-06-29
Name of individual signing SAWGRASS PEDIATRICS LLC
Valid signature Filed with authorized/valid electronic signature
SAWGRASS PEDIATRICS LLC 2009 201415382 2010-06-28 SAWGRASS PEDIATRICS LLC 29
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 9547529220
Plan sponsor’s address 9750 NW 33RD STREET, SUITE 101, CORAL SPRINGS, FL, 330650000

Plan administrator’s name and address
Administrator’s EIN 201415382
Plan administrator’s name SAWGRASS PEDIATRICS LLC
Plan administrator’s address 9750 NW 33RD STREET, SUITE 101, CORAL SPRINGS, FL, 330650000
Administrator’s telephone number 9547529220

Signature of
Role Plan administrator
Date 2010-06-28
Name of individual signing SAWGRASS PEDIATRICS LLC
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Martell Anthony MD Agent 9750 NW 33RD STEET, CORAL SPRINGS, FL, 33065

Manager

Name Role Address
MILLER LORI M Manager 9750 NW 33RD STREET, CORAL SPRINGS, FL, 33065
MUSSARY JORDAN M Manager 9750 NW 33RD STREET, CORAL SPRINGS, FL, 33065
MARTELL ANTHONY M Manager 9750 NW 33RD STREET, CORAL SPRINGS, FL, 33065
DI LIDDO ALINA M Manager 9750 NW 33RD STREET, CORAL SPRING, FL, 33065

Director

Name Role Address
MILLER LORI M Director 9750 NW 33RD STREET, CORAL SPRINGS, FL, 33065
DI LIDDO ALINA M Director 9750 NW 33RD STREET, CORAL SPRING, FL, 33065
MARTELL ANTHONY M Director 9750 NW 33RD STREET, CORAL SPRINGS, FL, 33065
MUSSARY JORDAN M Director 9750 NW 33RD STREET, CORAL SPRINGS, FL, 33065

Phys

Name Role Address
Cadiz Alan D.O. Phys 9750 NW 33RD STREET, CORAL SPRINGS, FL, 33065

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2022-01-20 Martell, Anthony, MD No data
CANCEL ADM DISS/REV 2006-10-05 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2006-09-15 No data No data
CHANGE OF PRINCIPAL ADDRESS 2005-05-11 9750 NW 33RD STREET, SUITE 101, CORAL SPRINGS, FL 33065 No data
CHANGE OF MAILING ADDRESS 2005-05-11 9750 NW 33RD STREET, SUITE 101, CORAL SPRINGS, FL 33065 No data
REGISTERED AGENT ADDRESS CHANGED 2005-05-11 9750 NW 33RD STEET, SUITE 101, CORAL SPRINGS, FL 33065 No data

Documents

Name Date
ANNUAL REPORT 2025-01-17
ANNUAL REPORT 2024-01-24
ANNUAL REPORT 2023-01-29
ANNUAL REPORT 2022-01-20
ANNUAL REPORT 2021-01-13
ANNUAL REPORT 2020-01-17
ANNUAL REPORT 2019-01-14
ANNUAL REPORT 2018-01-04
ANNUAL REPORT 2017-01-11
ANNUAL REPORT 2016-01-13

Related by officers

MILLER LORI M

LM ESTHETICS, LLC GIRL FRIDAY, LLC

MARTELL ANTHONY M

A PINK GLOVE SERVICE, LLC MARWOOD LLC

Related by address

9750 NW 33RD STREET, SUITE 101, CORAL SPRINGS, FL, 33065

ALLERGY, DERMATITIS AND ASTHMA, LLC

9750 NW 33RD STREET, SUITE 101, CORAL SPRINGS, FL, 33065

ALLERGY, DERMATITIS AND ASTHMA, LLC

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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