NPIMap

Organization Active NPI

Florida Department of Health

  • Public Health or Welfare Agency
  • Stuart, FL
National Provider Identifier
1013984863
Registry record updated Aug 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
FLORIDA DEPARTMENT OF HEALTH
Practice address
3441 SE Willoughby Blvd
Stuart, FL 34994-5060
Phone
(772) 221-4000
Fax
(772) 221-4989
NPI assigned
Mar 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2012

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

Authorized official

Name
Karlette J Peck
Title
Administrator
Phone
(772) 221-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X Primary

Addresses

Primary practice location

3441 SE Willoughby Blvd
Stuart, FL 34994-5060

Mailing address

3441 SE Willoughby Blvd
Stuart, FL 34994-5060
Phone (772) 221-4000

Other identifiers 1

IdentifierTypeStateIssuer
027953600MedicaidFL

Other names 1

  • Martin County Health Department Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100427000796 FL Part B Supplier - Clinic/Group Practice 3072424282 Receives reassigned benefits from 10 practitioners
Practice locations: Indiantown, FL; Stuart, FL

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0686109Martin County Health Department3441 SE Willoughby Blvd, Stuart, FL 34994Certificate of waiverMay 21, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Walton Community Health CenterDefuniak Springs, FL, CCN 101136 Federally qualified health center Operational/Managerial Control (100%) Sep 7, 2010
Bradford Community Health Care IncStarke, FL, CCN 101182 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2013

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344470400000",
    "number": "1013984863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3441 SE WILLOUGHBY BLVD",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349945060",
            "telephone_number": "772-221-4000",
            "fax_number": "772-221-4989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3441 SE WILLOUGHBY BLVD",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349945060",
            "telephone_number": "772-221-4000",
            "fax_number": "772-221-4989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DEPARTMENT OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-01",
        "last_updated": "2012-08-09",
        "status": "A",
        "authorized_official_last_name": "PECK",
        "authorized_official_first_name": "KARLETTE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "772-221-4000"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "027953600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martin County Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stuart, FL

Sources for this page

Verify at the official NPI Registry.