Sunlake Pain Management, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

HCC8458 Issued in FL

Legal business name

SUNLAKE PAIN MANAGEMENT, LLC

Practice address

18964 Dale Mabry Hwy N
Ste 101
Lutz, FL 33548-4913

Phone

(813) 948-2107

Fax

(813) 948-2790

NPI assigned

Jun 1, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Luis A. Logrono, MDNPI 1700875739

Title

Medical Director

Phone

(813) 948-2107

Specialties & licenses 1

Addresses

Other names 1

• Sunlake Medical Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

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

• Luis A Logrono, MD

  • Internal Medicine Physician
  • Lutz, FL
  • NPI 1700875739
  Medicare reassignment NPD Authorized official
• Hillary Millicent Heyliger, L.M.T.

  • Massage Therapist
  • Lutz, FL
  • NPI 1528346418
  NPD (past)

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

{
    "created_epoch": "1243814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270080000000",
    "number": "1114153483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18964 DALE MABRY HWY N",
            "address_2": "STE 101",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335484913",
            "telephone_number": "813-948-2107",
            "fax_number": "813-948-2790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18964 DALE MABRY HWY N",
            "address_2": "STE 101",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335484913",
            "telephone_number": "813-948-2107",
            "fax_number": "813-948-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNLAKE PAIN MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-01",
        "last_updated": "2010-04-01",
        "status": "A",
        "authorized_official_last_name": "LOGRONO",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "813-948-2107",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "HCC8458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunlake Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sonya M Sumpter, MD
• Sun Dental Inc
• Suncoast Skin Solutions
• Suncoast U R L L C
• Suncoast Ur Inc
• Sunny Side Up Therapy and Consulting, LLC
• Sunshine Family Psych & Wellness LLC
• Sunshine Primary Care LLC
• Support Associates of Tampa Bay, Inc
• Supported Employment and Living Facilitators, Inc.

• Clinic/Center in Lutz, FL
• Providers in Lutz, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2010; 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.