NPIMap

Organization Active NPI

Sunshine State Medical Clinic PA

  • Internal Medicine Physician
  • Ocala, FL
National Provider Identifier
1063683126
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME73537 Issued in FL
Legal business name
SUNSHINE STATE MEDICAL CLINIC PA
Practice address
1305 SE 25TH Loop Ste 103
Ocala, FL 34471-6090
Phone
(352) 369-5440
Fax
(352) 369-5442
NPI assigned
Mar 17, 2008
Last updated
Jun 27, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2008

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

Authorized official

Name
Dr. Uday Shanker Mishra, MDNPI 1275636474
Title
President
Phone
(352) 369-5440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME73537 FL Primary

Addresses

Primary practice location

1305 SE 25TH Loop Ste 103
Ocala, FL 34471-6090

Mailing address

1305 SE 25TH Loop Suit 103
Ocala, FL 34471
Phone (352) 369-5440

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040922000979 FL Part B Supplier - Clinic/Group Practice 5890763213 Receives reassigned benefits from 2 practitioners
Practice locations: Ocala, FL

National Provider Directory

National Provider Directory
Tax ID family
Sunshine State Medical Clinic2 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.

Locations

1305 SE 25th Loop
#103
Ocala, FL 34471
Phone (352) 369-5440

1315 SE 25th Loop
Ste 4
Ocala, FL 34471
Phone (352) 369-5440

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1063683126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 SE 25TH LOOP SUIT 103",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "34471",
            "telephone_number": "352-369-5440",
            "fax_number": "352-369-5442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 SE 25TH LOOP STE 103",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344716090",
            "telephone_number": "352-369-5440",
            "fax_number": "352-369-5442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNSHINE STATE MEDICAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-17",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "MISHRA",
        "authorized_official_first_name": "UDAY",
        "authorized_official_middle_name": "SHANKER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-369-5440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME73537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocala, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; 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.