Southern Breeze Primary Care, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SOUTHERN BREEZE PRIMARY CARE, LLC

Practice address

107 W 19TH St
Panama City, FL 32405-4647

Phone

(850) 527-6489

NPI assigned

Dec 13, 2024

Organization subpart

No

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

Authorized official

Name

Lisa Leanne King

Title

Administrator

Phone

(850) 527-6489

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Holly Elizabeth Gay, APRN-C

  • Family Nurse Practitioner
  • Panama City, FL
  • NPI 1649941139
  Medicare reassignment NPD

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

{
    "created_epoch": "1734048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734048000000",
    "number": "1114734183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6506 GARDENIA ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324045162",
            "telephone_number": "850-527-6489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 W 19TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054647",
            "telephone_number": "850-527-6489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN BREEZE PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-13",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "LEANNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "850-527-6489"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sonrisa Panama City LLC
• Michelle Sosa
• Jay Sourbeer, M.D.
• Southeastern Dermatology Group PA
• Southern Bay Anesthesia & Pain Management PA
• Southern Dietetics, Inc.
• Southern Eye Specialists PC
• Southern Health Partners, Inc.
• Southern Home Care Services, Inc.
• Southern Living Homecare LLC

• Primary Care Clinic/Center in Panama City, FL
• Providers in Panama City, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.