Millennium Cardiovascular Associates Inc

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

Legal business name

MILLENNIUM CARDIOVASCULAR ASSOCIATES INC

Practice address

901 Venetia Bay Blvd Ste 200
Venice, FL 34285-8046

Phone

(941) 497-5511

NPI assigned

Oct 12, 2022

Organization subpart

No

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

Authorized official

Name

Sabry Omar, MDNPI 1689939910

Title

President

Phone

(213) 479-4451

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sabry Ahmad Omar, MD

  • Interventional Cardiology Physician
  • Venice, FL
  • NPI 1689939910

  Cardiovascular Disease, FL

  Medicare reassignment Care Compare group NPD Authorized official
• Shelly Lynn Buckley, APRN

  • Family Nurse Practitioner
  • Sarasota, FL
  • NPI 1740360122

  FL

  Medicare reassignment Care Compare group NPD
• Julie Dickinson, ARNP

  • Gerontology Nurse Practitioner
  • Venice, FL
  • NPI 1609372267

  FL, Single Specialty

  Medicare reassignment Care Compare group NPD
• Marisa Siddell Fetherolf, APRN

  • Family Nurse Practitioner
  • Venice, FL
  • NPI 1376387514

  FL

  Medicare reassignment Care Compare group NPD
• Jose Jacob, M.D.

  • Cardiovascular Disease Physician
  • Leesburg, FL
  • NPI 1194771832

  Cardiovascular Disease, FL

  Medicare reassignment Care Compare group NPD
• Robin Nebbia, NP

  • Nurse Practitioner
  • Venice, FL
  • NPI 1568603173

  FL

  Medicare reassignment Care Compare group NPD
• Amber Rowan, APRN

  • Family Nurse Practitioner
  • Venice, FL
  • NPI 1023572906

  FL

  Medicare reassignment Care Compare group NPD
• Abdul Kader Ezeldin, MD

  • Interventional Cardiology Physician
  • Kissimmee, FL
  • NPI 1639129133

  Cardiovascular Disease, FL

  Medicare reassignment NPD
• Premala Raja, MD

  • Cardiovascular Disease Physician
  • Englewood, FL
  • NPI 1194736504

  Cardiovascular Disease, FL

  Medicare reassignment NPD
• William Scott Woolverton, M.D.F.A.C.C.

  • Cardiovascular Disease Physician
  • Venice, FL
  • NPI 1679579015

  Cardiovascular Disease, FL

  Medicare reassignment NPD

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

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1013633072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 VENETIA BAY BLVD STE 200",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342858046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 VENETIA BAY BLVD STE 200",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342858046",
            "telephone_number": "941-497-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLENNIUM CARDIOVASCULAR ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-12",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A",
        "authorized_official_last_name": "OMAR",
        "authorized_official_first_name": "SABRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-479-4451",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luc Michiels, P.T.
• Madonna Mifsud Pachota, ARNP
• Phillip M Mihm, M.D.
• Susan Rucker Mihm, M.D.
• Mila Seguerra-Doctura MD PA
• Millennium Physician Group LLC
• Millennium Physician Group LLC
• Millennium Physician Group LLC
• Gregory Bruce Miller, P.T.
• Kathryn M. Miller, M.S.

• All providers in Venice, FL
• Interventional Cardiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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.