Active NPI
Family Care Medical Center II LLC
- Family Medicine Physician
- Arcadia, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- FAMILY CARE MEDICAL CENTER II LLC
- Practice address
- 819 N Mills Ave
Arcadia, FL 34266-8716 - Phone
- (863) 491-2277
- Fax
- (863) 491-3077
- NPI assigned
- Dec 29, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kenan M Cetin, PA-C
- Title
- Owner
- Phone
- (863) 491-2277
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary | ||
| Medical Physician Assistant | 363AM0700X |
Addresses
Primary practice location
819 N Mills Ave
Arcadia, FL 34266-8716
Mailing address
819 N Mills Ave
Arcadia, FL 34266-8716
Phone (863) 491-2277
Other names 1
- Family Care Medical Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 2
Rural health clinic certification: CCN 683838
- Legal name
- FAMILY CARE MEDICAL CENTER II LLC
- Doing business as
- FAMILY CARE MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 19, 2021
- Last certification
- May 19, 2021
- Ownership / control type
- 1B
- Organization structure
- LLC
- Enrollment address
- 819 N Mills Ave
Ste B&C
Arcadia, FL 34266-8716
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Rural Health Clinic/Center
- Arcadia, FL
- NPI 1225609597
O20210113001197, O20210310000010
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Achilles Kalnoky | Contracted Managing Employee | Feb 8, 2021 | |
| Corporate Director | Feb 8, 2021 | ||
| Kenan Murat Cetin | 5% Or Greater Direct Ownership Interest | Dec 3, 2020 | 95% |
| W-2 Managing Employee | Dec 3, 2020 |
Owners & managing parties with NPI records 2
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Medical Physician Assistant
- Arcadia, FL
- NPI 1801864954
5% Or Greater Direct Ownership Interest, W-2 Managing Employee
-
- Family Medicine Physician
- Sarasota, FL
- NPI 1245460690
Contracted Managing Employee, Corporate Director
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Medical Physician Assistant
- Arcadia, FL
- NPI 1801864954
-
- Physician Assistant
- Arcadia, FL
- NPI 1578277877
-
- Family Medicine Physician
- Sarasota, FL
- NPI 1245460690
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609200000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1626825600000",
"number": "1114514809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "819 N MILLS AVE",
"city": "ARCADIA",
"state": "FL",
"postal_code": "342668716",
"telephone_number": "863-491-2277",
"fax_number": "863-491-3077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "819 N MILLS AVE",
"city": "ARCADIA",
"state": "FL",
"postal_code": "342668716",
"telephone_number": "863-491-2277",
"fax_number": "863-491-3077"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FAMILY CARE MEDICAL CENTER II LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-12-29",
"last_updated": "2021-07-21",
"certification_date": "2021-07-21",
"status": "A",
"authorized_official_last_name": "CETIN",
"authorized_official_first_name": "KENAN",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "863-491-2277",
"authorized_official_credential": "PA-C"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Family Care Medical Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Family Care Medical Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Arcadia, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.