NPIMap

Organization Active NPI

Intercommunity Cancer Center - Lady Lake Campus LLC

  • Radiation Oncology Physician
  • Lady Lake, FL
National Provider Identifier
1013903699
Registry record updated Jan 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
INTERCOMMUNITY CANCER CENTER - LADY LAKE CAMPUS LLC
Practice address
922 Rolling Acres Rd
Lady Lake, FL 32159-5022
Phone
(352) 753-6198
Fax
(352) 326-8335
NPI assigned
Sep 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2012

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

Authorized official

Name
Hal M Jacobson
Title
Medical Director
Phone
(352) 326-2224

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

922 Rolling Acres Rd
Lady Lake, FL 32159-5022

Mailing address

PO Box 863359
Orlando, FL 32886-3359
Phone (352) 326-2224

Other identifiers 2

IdentifierTypeStateIssuer
DE8303OtherFLRR MEDICARE
273918600MedicaidFL

National Provider Directory

National Provider Directory

Locations

922 Rolling Acres Rd
Ste 1
Lady Lake, FL 32159
Phone (352) 674-6300

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327881600000",
    "number": "1013903699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 863359",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328863359",
            "telephone_number": "352-326-2224",
            "fax_number": "352-326-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "922 ROLLING ACRES RD",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321595022",
            "telephone_number": "352-753-6198",
            "fax_number": "352-326-8335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCOMMUNITY CANCER CENTER - LADY LAKE CAMPUS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-20",
        "last_updated": "2012-01-30",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "HAL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "352-326-2224"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DE8303",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273918600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lady Lake, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.