Adventist Health System-Sunbelt Inc
Organization Active NPI Rural Health Clinic/Center · Frostproof, FL
NPI 1013434067 · NPPES record last updated Apr 21, 2025
Key facts
- NPI
- 1013434067
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ADVENTIST HEALTH SYSTEM-SUNBELT INC
- Practice address
- 200 S Scenic Hwy
Frostproof, FL 33843-2125 - Phone
- (863) 546-6384
- NPI assigned
- Aug 29, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- ADVENTIST HEALTH SYSTEM-SUNBELT INC
Authorized official
- Name
- Jason Dunkel
- Title
- Ceo
- Phone
- (727) 942-5002
Owners & managing parties with NPI records 4
-
Richard A Campbell, M.D.
-
William Anthony Fields, M.D.
-
Witford L Reid, M.D.
-
Thomas Shimshak, M.D.
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 1
Related certifications (CCN) 1
Facilities with the same owner 88
Practitioners 100
-
Rey Francisco Arcenas, M.D.
-
Smriti Banthia, M.D.
-
Deepti Bhandare, MD
-
David Justin Blalock, ARNP
-
Kristen Green Bloodworth, APRN, FNP- C
-
Rebecca L Bowden, D.O.
-
Carlos A. Carrillo, M.D.
-
Dianna L Chizmas, ARNP
-
Keith O Coker, PA
-
Brittany Davidson, FNP-C
-
Nicole Elaine Davis, MD, PHARMD
-
Terrence Delikat, DO
-
Roberto J Diaz, MD
-
Shayan Faiq, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Rural health clinic certification: CCN 103975
- Legal name
- ADVENTIST HEALTH SYSTEM-SUNBELT INC
- Doing business as
- ADVENTHEALTH FAMILY MEDICINE FROSTPROOF
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 27, 2018
- Last certification
- Dec 27, 2018
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 2, 1973 in FL
- Enrollment address
- 200 S Scenic Hwy
Frostproof, FL 33843-2125 - Related CCNs
- 101300
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| Jason Dunkel |
Contracted Managing Employee | Jul 31, 2022 | |
| Corporate Officer |
Dec 8, 2022 | ||
| Corporate Director |
Aug 25, 2022 | ||
| Operational/Managerial Control |
Jul 31, 2022 | ||
| Fred Hawkins |
Corporate Director |
Dec 7, 2023 | |
| Dini H Rada |
Corporate Director |
Aug 22, 2024 | |
| Richard K Justice |
Corporate Director |
Sep 18, 2008 | |
| William Chen |
Corporate Director |
Feb 17, 2022 | |
| William a Fields |
Corporate Director |
Feb 16, 2023 | |
| Terry Atchley |
Corporate Director |
Dec 5, 2013 | |
| Witford L Reid |
Corporate Director |
Aug 22, 2024 | |
| Jeffrey Chilson |
Contracted Managing Employee |
Sep 15, 2025 | |
| Corporate Officer |
Sep 15, 2025 | ||
| Operational/Managerial Control |
Sep 15, 2025 | ||
| Timothy Clark |
Corporate Director |
Dec 8, 2022 | |
| Penny Herman |
W-2 Managing Employee |
Oct 1, 2010 | |
| Thomas Michael Shimshak |
Corporate Director |
Dec 10, 2020 | |
| Adventist Health System Sunbelt Healthcare Corporation |
5% Or Greater Indirect Ownership Interest | Mar 1, 2016 | 100% |
| William R Jarrett |
Corporate Director |
Sep 13, 2007 | |
| Jennifer J Wandersleben |
Corporate Officer |
Dec 2, 2021 | |
| Corporate Director |
Dec 2, 2021 | ||
| Timothy Sheehan |
Corporate Director |
Dec 17, 2009 | |
| Catherine Cornelius |
Corporate Director |
Aug 18, 2005 | |
| Richard a Campbell |
Corporate Director |
Dec 5, 2013 | |
| Adventist Health System Sunbelt Inc |
5% Or Greater Direct Ownership Interest | Mar 1, 2016 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171117000110 | FL | Part a Provider - Rural Health Clinic | 0749232445 | Practice locations: Frostproof, FL |
National Provider Directory
- Tax ID family
- Erick Calderon MD
- Part of
- Erick Calderon MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Medical Physician Assistant |
363AM0700X |
Addresses
Primary practice location
200 S Scenic Hwy
Frostproof, FL 33843-2125
Mailing address
4101 Sun N Lake Blvd
Sebring, FL 33872-2131
Phone (863) 314-4466
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010260100 | Medicaid | FL |
Other names
- ADVENTHEALTH FAMILY MEDICINE FROSTPROOF
- Frostproof Family Health
Other providers in Frostproof, FL
- Alvaro J Jarquin MD PA
- Patricia Beckwith
- Amanda L Blitz
- Sardul S Brar
- Central Florida Health Care, Inc
All providers in Frostproof, FL · Rural Health Clinic/Center in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.