NPIMap

Organization Active NPI

Florida Community Health Centers Inc

  • Pediatrics Physician
  • West Palm Beach, FL
National Provider Identifier
1043260490
Registry record updated Sep 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
FLORIDA COMMUNITY HEALTH CENTERS INC
Practice address
4450 S Tiffany Dr
West Palm Beach, FL 33407-3241
Phone
(561) 844-9443
Fax
(561) 844-1013
NPI assigned
May 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2011

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

Authorized official

Name
Dr. Michael F Gervasi, D.O.
Title
President & Ceo
Phone
(561) 844-9443

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Federally Qualified Health Center (FQHC) 261QF0400X

Addresses

Primary practice location

4450 S Tiffany Dr
West Palm Beach, FL 33407-3241

Mailing address

4450 S Tiffany Dr
West Palm Beach, FL 33407-3241
Phone (561) 844-9443

Other identifiers 2

IdentifierTypeStateIssuer
029574414MedicaidFL
029574415MedicaidFL

Other names 1

  • Lakeshore Pediatrics Annex Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040515000037 FL Part B Supplier - Clinic/Group Practice 9931017126 Receives reassigned benefits from 95 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Okeechobee, FL; West Palm Beach, FL; Stuart, FL; Port St. Lucie, FL; Port St Lucie, FL; Pahokee, FL; Moore Haven, FL; Indiantown, FL…

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

National Provider Directory

National Provider Directory

Locations

4450 S Tiffany Dr
Mangonia Park, FL 33407
Phone (561) 844-9443

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315267200000",
    "number": "1043260490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4450 S TIFFANY DR",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334073241",
            "telephone_number": "561-844-9443",
            "fax_number": "561-844-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4450 S TIFFANY DR",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334073241",
            "telephone_number": "561-844-9443",
            "fax_number": "561-844-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA COMMUNITY HEALTH CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2011-09-06",
        "status": "A",
        "authorized_official_last_name": "GERVASI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "561-844-9443",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029574414",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029574415",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeshore Pediatrics Annex",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in West Palm Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.