NPIMap

Organization Active NPI

Port Charlotte Hma Physician Management LLC

Doing business as Neurology Associates of Charlotte County

  • Neurology Physician
  • Port Charlotte, FL
National Provider Identifier
1053983338
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
Doing business as
Neurology Associates of Charlotte County
Port Charlotte HMA Physician Management LLC
Practice address
3067 Tamiami TRL Ste 2
Port Charlotte, FL 33952-6619
Phone
(941) 225-8351
Fax
(941) 258-3519
NPI assigned
Jul 15, 2021
Last updated
Mar 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2022

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

Authorized official

Name
Jennifer L Jackson
Title
Sr Dir Prov Enrollment & Onboarding
Phone
(615) 465-3334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X NU Primary

Addresses

Primary practice location

3067 Tamiami TRL Ste 2
Port Charlotte, FL 33952-6619

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-7211

Other identifiers 1

IdentifierTypeStateIssuer
278507205MedicaidFL

Other names 2

  • NEUROLOGY ASSOCIATES OF CHARLOTTE COUNTY Doing business as
  • Port Charlotte HMA Physician Management LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Port Charlotte Hma Physician MGMT LLC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1053983338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-7211",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3067 TAMIAMI TRL STE 2",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526619",
            "telephone_number": "941-225-8351",
            "fax_number": "941-258-3519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-15",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR DIR PROV ENROLLMENT & ONBOARDING",
        "authorized_official_telephone_number": "615-465-3334"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278507205",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEUROLOGY ASSOCIATES OF CHARLOTTE COUNTY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NEUROLOGY ASSOCIATES OF CHARLOTTE COUNTY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Port Charlotte HMA Physician Management LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.