NPIMap

Organization Active NPI

M & M Rehab Inc

  • Prosthetic/Orthotic Supplier
  • Lake City, FL
National Provider Identifier
1003022351
Registry record updated Aug 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
M & M REHAB INC
Practice address
221 SW Stonegate Ter Ste 107
Lake City, FL 32024-3463
Phone
(386) 755-5774
Fax
(352) 331-9927
NPI assigned
May 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Victor Bustamante, CPO
Title
President
Phone
(352) 331-3399

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

221 SW Stonegate Ter Ste 107
Lake City, FL 32024-3463

Mailing address

6608 NW 9TH Blvd
Gainesville, FL 32605-4207
Phone (352) 331-3399

Other names 1

  • MID-FLORIDA PROSTHETICS & ORTHOTICS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930057571 FL DME Supplier - Orthotic PersonnelDME Supplier - Prosthetic Personnel 5698896058 Practice locations: Lake City, FL

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Mid-Florida Prosthetics & Orthotics221 SW Stonegate Ter, Lake City, FL 32024-3463(386) 755-5774 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom Does not accept assignmentParticipating since Jan 1, 2015

National Provider Directory

National Provider Directory
Tax ID family
M and M Rehab Dba Ortho7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

221 SW Stonegate Ter
Ste 107
Lake City, FL 32024
Phone (386) 755-5774

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596758400000",
    "number": "1003022351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6608 NW 9TH BLVD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054207",
            "telephone_number": "352-331-3399",
            "fax_number": "352-331-9927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 SW STONEGATE TER STE 107",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320243463",
            "telephone_number": "386-755-5774",
            "fax_number": "352-331-9927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M & M REHAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A",
        "authorized_official_last_name": "BUSTAMANTE",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-331-3399",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MID-FLORIDA PROSTHETICS & ORTHOTICS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MID-FLORIDA PROSTHETICS & ORTHOTICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.