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  5. PEDIATRIC GASTROENTEROLOGY ASSOCIATES, PLLC

PEDIATRIC GASTROENTEROLOGY ASSOCIATES, PLLC

Company Details

Entity Name: PEDIATRIC GASTROENTEROLOGY ASSOCIATES, PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 28 Sep 2015 (9 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 04 Oct 2022 (2 years ago)
Document Number: L15000169247
FEI/EIN Number 56-2319289
Address: 10045 S DIXIE HWY, PINECREST, FL, 33156, US
Mail Address: 10045 S DIXIE HWY, PINECREST, FL, 33156, US
ZIP code: 33156
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1295766558 2006-07-05 2020-12-08 3200 SW 60TH CT STE 204, MIAMI, FL, 331554070, US 8955 SW 87TH CT STE 206, MIAMI, FL, 331762223, US

Contacts
Phone +1 305-661-6110
Fax 3056625882
Phone +1 786-888-2480

Authorized person
Name DR. JESSE REEVES-GARCIA
Role PRESIDENT
Phone 3056616110

Taxonomy
Taxonomy Code 2080P0206X - Pediatric Gastroenterology Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 377245400
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PEDIATRIC GASTROENTEROLOGY ASSOCIATES, PLLC 401(K) PLAN 2023 562319289 2024-06-19 PEDIATRIC GASTROENTEROLOGY ASSOCIATES, PLLC 30
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2020-01-01
Business code 621111
Sponsor’s telephone number 3056616110
Plan sponsor’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155

Signature of
Role Plan administrator
Date 2024-06-19
Name of individual signing WILLIAM MUINOS, MD
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC GASTROENTEROLOGY ASSOCIATES, PLLC 401(K) PLAN 2022 562319289 2023-10-11 PEDIATRIC GASTROENTEROLOGY ASSOCIATES, PLLC 23
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2020-01-01
Business code 621111
Sponsor’s telephone number 3056616110
Plan sponsor’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155

Signature of
Role Plan administrator
Date 2023-10-11
Name of individual signing WILLIAM MUINOS, MD
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC GASTROENTEROLOGY ASSOCIATES, PLLC 401(K) PLAN 2021 562319289 2022-06-27 PEDIATRIC GASTROENTEROLOGY ASSOCIATES, PLLC 24
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2020-01-01
Business code 621111
Sponsor’s telephone number 3056616110
Plan sponsor’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155

Signature of
Role Plan administrator
Date 2022-06-27
Name of individual signing WILLIAM MUINOS
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC GASTROENTEROLOGY ASSOCIATES, PLLC 401(K) PLAN 2020 562319289 2021-10-05 PEDIATRIC GASTROENTEROLOGY ASSOCIATES, PLLC 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2020-01-01
Business code 621111
Sponsor’s telephone number 3056616110
Plan sponsor’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155

Signature of
Role Plan administrator
Date 2021-10-05
Name of individual signing WILLIAM MUINOS
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC GASTROENTEROLOGY ASSOCIATES 401(K) PROFIT SHARING PLAN 2017 562319289 2018-06-12 PEDIATRIC GASTROENTEROLOGY ASSOCIATES 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3056616110
Plan sponsor’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155

Plan administrator’s name and address
Administrator’s EIN 562319289
Plan administrator’s name PEDIATRIC GASTROENTEROLOGY ASSOCIATES
Plan administrator’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155
Administrator’s telephone number 3056616110

Signature of
Role Plan administrator
Date 2018-06-12
Name of individual signing WILLIAM MUINOS, MD
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC GASTROENTEROLOGY ASSOCIATES 401(K) PS PLAN 2017 562319289 2018-08-29 PEDIATRIC GASTROENTEROLOGY ASSOCIATES 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3056616110
Plan sponsor’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155

Signature of
Role Plan administrator
Date 2018-08-29
Name of individual signing WILLIAM MUINOS, MD
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC GASTROENTEROLOGY ASSOCIATES 401(K) PROFIT SHARING PLAN 2016 562319289 2017-05-30 PEDIATRIC GASTROENTEROLOGY ASSOCIATES 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3056616110
Plan sponsor’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155

Plan administrator’s name and address
Administrator’s EIN 562319289
Plan administrator’s name PEDIATRIC GASTROENTEROLOGY ASSOCIATES
Plan administrator’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155
Administrator’s telephone number 3056616110

Signature of
Role Plan administrator
Date 2017-05-30
Name of individual signing WILLIAM MUINOS, MD
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC GASTROENTEROLOGY ASSOCIATES 401(K) PROFIT SHARING PLAN 2015 562319289 2016-05-13 PEDIATRIC GASTROENTEROLOGY ASSOCIATES 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3056616110
Plan sponsor’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155

Plan administrator’s name and address
Administrator’s EIN 562319289
Plan administrator’s name PEDIATRIC GASTROENTEROLOGY ASSOCIATES
Plan administrator’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155
Administrator’s telephone number 3056616110

Signature of
Role Plan administrator
Date 2016-05-13
Name of individual signing WILLIAM MUINOS, MD
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC GASTROENTEROLOGY ASSOCIATES 401(K) PROFIT SHARING PLAN 2014 562319289 2015-06-22 PEDIATRIC GASTROENTEROLOGY ASSOCIATES 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3056616110
Plan sponsor’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155

Plan administrator’s name and address
Administrator’s EIN 562319289
Plan administrator’s name PEDIATRIC GASTROENTEROLOGY ASSOCIATES
Plan administrator’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155
Administrator’s telephone number 3056616110

Signature of
Role Plan administrator
Date 2015-06-22
Name of individual signing WILLIAM MUINOS, MD
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC GASTROENTEROLOGY ASSOCIATES 401(K) PROFIT SHARING PLAN 2013 562319289 2014-05-06 PEDIATRIC GASTROENTEROLOGY ASSOCIATES 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3056616110
Plan sponsor’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155

Plan administrator’s name and address
Administrator’s EIN 562319289
Plan administrator’s name PEDIATRIC GASTROENTEROLOGY ASSOCIATES
Plan administrator’s address 3200 SW 60 COURT, SUITE 204, MIAMI, FL, 33155
Administrator’s telephone number 3056616110

Signature of
Role Plan administrator
Date 2014-05-06
Name of individual signing WILLIAM MUINOS, MD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
PEDIATRIC GASTROENTEROLOGY ASSOCIATES, PLLC Agent

Authorized Member

Name Role Address
MUINOS WILLIAM Authorized Member 8955 SW 87TH CT, MIAMI, FL, 33176
REEVES-GARCIA JESSE M.D. Authorized Member 8955 SW 87TH CT, MIAMI, FL, 33176
GOMARA ROBERTO EM.D. Authorized Member 8955 SW 87TH CT, MIAMI, FL, 33176
HERNANDEZ ERICK Authorized Member 8955 SW 87TH CT, MIAMI, FL, 33176
ARBOLEDA RICHARD NM.D. Authorized Member 8955 SW 87TH CT, MIAMI, FL, 33176

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-05-02 10045 S DIXIE HWY, PINECREST, FL 33156 No data
CHANGE OF MAILING ADDRESS 2024-05-02 10045 S DIXIE HWY, PINECREST, FL 33156 No data
REINSTATEMENT 2022-10-04 No data No data
REGISTERED AGENT NAME CHANGED 2022-10-04 Pediatric Gastroenterology Associates No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2022-09-23 No data No data
LC AMENDMENT 2020-12-09 No data No data
CONVERSION 2015-09-28 No data GEN-COR CONVERSION RESULT. THE CONVERTING ENTITY WAS GP0300000459 ORIGINALLY FILED ON 03/05/2003. CONVERSION NUMBER 500000154745

Documents

Name Date
AMENDED ANNUAL REPORT 2024-01-31
ANNUAL REPORT 2024-01-18
ANNUAL REPORT 2023-02-01
REINSTATEMENT 2022-10-04
ANNUAL REPORT 2021-02-09
LC Amendment 2020-12-09
ANNUAL REPORT 2020-03-17
ANNUAL REPORT 2019-05-01
ANNUAL REPORT 2018-04-30
ANNUAL REPORT 2017-03-20

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Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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