Blueshine Medical Center LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

BLUESHINE MEDICAL CENTER LLC

Practice address

140 Santa Barbara Blvd Ste 121
Cape Coral, FL 33991-2160

Phone

(305) 790-6544

NPI assigned

Sep 23, 2024

Last updated

Sep 23, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jose Gustavo Cevallos, MD

Title

Provider

Phone

(305) 790-6544

Specialties & licenses 1

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 3

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.

• Jose Gustavo Cevallos Yepez, M.D.

  • Internal Medicine Physician
  • Cape Coral, FL
  • NPI 1922236736
  Medicare reassignment NPD
• Manuel J Castellanos, M.D

  • Pediatrics Physician
  • Miami, FL
  • NPI 1578571113
  NPD (past)
• Francisco Omar Hernandez, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Miami, FL
  • NPI 1265413538

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1727049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1053138099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 NW 15TH PL",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339937747",
            "telephone_number": "561-762-1660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 SANTA BARBARA BLVD STE 121",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339912160",
            "telephone_number": "305-790-6544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUESHINE MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-23",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-22",
        "status": "A",
        "authorized_official_last_name": "CEVALLOS",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "GUSTAVO",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "305-790-6544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacquelyn Blondin
• Bloom & Grow Therapy LLC
• Blue Friends ABA Therapy LLC
• Blue Hope Behavioral Services, Inc
• Blue Jay Behavior Services LLC
• Bluewave Chiropractic LLC
• Jacquelyn Boberg, APRN
• Body Essential Massage Inc
• Jacobus Bogaards
• Bohorques Wellness Services LLC

• General Practice Physician in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; 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.