South Lake Primary Care P a

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

ME0071348 Issued in FL

Legal business name

SOUTH LAKE PRIMARY CARE P A

Practice address

1503 Sunrise Plaza Dr
Clermont, FL 34714-6200

Phone

(352) 243-3800

Fax

(352) 243-3804

NPI assigned

Nov 22, 2010

Organization subpart

No

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

Authorized official

Name

Ramon Sueiro, MDNPI 1790854560

Title

MD

Phone

(352) 243-3800

Specialties & licenses 1

Addresses

Other identifiers 1

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

Tax ID family

South Lake Primary Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• South Lake Primary Care P a

  • Family Medicine Physician
  • Mascotte, FL
  • NPI 1164783528
  NPD tax ID

Locations

Practitioners 1

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

• Ramon Sueiro, MD

  • Family Medicine Physician
  • Clermont, FL
  • NPI 1790854560

  FL

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1290384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377820800000",
    "number": "1053613232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 SUNRISE PLAZA DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347146200",
            "telephone_number": "352-243-3800",
            "fax_number": "352-243-3804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 SUNRISE PLAZA DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347146200",
            "telephone_number": "352-243-3800",
            "fax_number": "352-243-3804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LAKE PRIMARY CARE P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-22",
        "last_updated": "2013-08-30",
        "status": "A",
        "authorized_official_last_name": "SUEIRO",
        "authorized_official_first_name": "RAMON",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "352-243-3800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ME0071348",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250594100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Lake Medical Center Inc
• South Lake Medicine P a
• South Lake Obstetrics & Gynecology, LLC
• South Lake Pain Institute, Inc
• South Lake Pediatrics, P.a.
• South Lake Wellness & Injury Center, PL
• Southlake Autism and Behavior Services, PA
• Sarah Michelle Spangler
• Yumika Sparkman, MSW, LCSW
• Kristin Spear

• All providers in Clermont, FL
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2013; 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.