NPIMap

Organization Active NPI

Leesburg Regional Medical Center Physician Services LLC

  • Emergency Medicine Physician
  • Leesburg, FL
National Provider Identifier
1104063114
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
LEESBURG REGIONAL MEDICAL CENTER PHYSICIAN SERVICES LLC
Practice address
600 E Dixie Ave
Leesburg, FL 34748-5925
Phone
(523) 594-0827
Fax
(352) 323-5039
NPI assigned
Jan 13, 2009
Last updated
Nov 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

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

Authorized official

Name
Mrs. Heather Long
Title
President, Ceo
Phone
(352) 323-5761

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X ME102387 FL
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X ME101492 FL
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X ME062340 FL

Addresses

Primary practice location

600 E Dixie Ave
Leesburg, FL 34748-5925

Mailing address

600 E Dixie Ave
Leesburg, FL 34748-5925
Phone (352) 323-5002

Other practice location 1

17021 US Highway 441
Mount Dora, FL 32757-6734
Phone (523) 594-0827

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090526000395 FL Part B Supplier - Clinic/Group Practice 8426107327 Receives reassigned benefits from 97 practitioners
Practice locations: Mt. Dora, FL

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1400 N US Highway 441
Ste 5
Lady Lake, FL 32159

1501 N US Highway 441
Fl 2
Lady Lake, FL 32159

1501 N US Highway 441
Ste 1830
The Villages, FL 32159
Phone (352) 391-9200

1501 N US Highway 441
Ste 1832
The Villages, FL 32159
Phone (352) 391-5186

Practitioners & affiliated clinicians

Practitioners 100

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.

View all 100

NPI Registry JSON

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

{
    "created_epoch": "1231804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1104063114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E DIXIE AVE",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485925",
            "telephone_number": "352-323-5002",
            "fax_number": "352-323-5039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E DIXIE AVE",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485925",
            "telephone_number": "523-594-0827",
            "fax_number": "352-323-5039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17021 US Highway 441",
            "address_purpose": "LOCATION",
            "city": "Mount Dora",
            "state": "FL",
            "postal_code": "327576734",
            "country_code": "US",
            "telephone_number": "523-594-0827",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEESBURG REGIONAL MEDICAL CENTER PHYSICIAN SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-13",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "352-323-5761",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME102387",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME101492",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME062340",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; 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.