Adventhealth Polk South Inc

Primary specialty

Psychiatric Hospital UnitTaxonomy code 273R00000X

Legal business name

ADVENTHEALTH POLK SOUTH INC

Practice address

410 S 11TH St
Lake Wales, FL 33853-4203

Phone

(863) 676-1433

Fax

(863) 297-1867

NPI assigned

Jun 27, 2019

Organization subpart

Yes

Parent organization

ADVENTHEALTH POLK SOUTH INCAs reported in NPPES

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

Authorized official

Name

Alan Justin Hengesbach

Title

Cfo

Phone

(863) 419-2260

Specialties & licenses 1

Addresses

Other names 1

• AdventHealth Lake Wales Doing business as

Electronic endpoints 1

Part of

Adventhealth Polk South Inc

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Adventhealth Polk South Inc

  • General Acute Care Hospital
  • Lake Wales, FL
  • NPI 1053972760

  Member Of

  NPD member

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Adventhealth Polk South Inc

  • General Acute Care Hospital
  • Lake Wales, FL
  • NPI 1053972760
  NPPES parent name

Practitioners 2

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

• Julia Hunt Berkau, PT

  • Physical Therapist
  • Lake Wales, FL
  • NPI 1932876141
  NPD (past)
• Mark Francis Pangilinan, DPT

  • Physical Therapist
  • Lake Wales, FL
  • NPI 1962199059
  NPD (past)

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

{
    "created_epoch": "1561593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652832000000",
    "number": "1033770284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 S 11TH ST",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534203",
            "telephone_number": "863-676-1433",
            "fax_number": "863-297-1867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 S 11TH ST",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534203",
            "telephone_number": "863-676-1433",
            "fax_number": "863-297-1867"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14055 Riveredge Dr Ste 250",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336372141",
            "country_code": "US",
            "telephone_number": "863-419-2260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVENTHEALTH POLK SOUTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVENTHEALTH POLK SOUTH INC",
        "enumeration_date": "2019-06-27",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A",
        "authorized_official_last_name": "HENGESBACH",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "JUSTIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "863-419-2260"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "AdventHealth Lake Wales",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AdventHealth Lake Wales",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Lake Wales, FL
• Psychiatric Hospital Unit in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2022; 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.