Organization Active NPI

Physicians for Accountable Care, LLC

  • Radiation Oncology Physician
  • Lady Lake, FL
National Provider Identifier
1124014709
Registry record updated Mar 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
PHYSICIANS FOR ACCOUNTABLE CARE, LLC
Practice address
922 Rolling Acres Rd Ste 1
Lady Lake, FL 32159-5037
Phone
(352) 674-6300
Fax
(353) 753-6399
NPI assigned
Sep 20, 2005
Last updated
Mar 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2022

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

Authorized official

Name
Rebecca Grohler
Title
Manager
Phone
(352) 674-6300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X NU Primary
Urology Physician 208800000X NU

Addresses

Primary practice location

922 Rolling Acres Rd Ste 1
Lady Lake, FL 32159-5037

Mailing address

922 Rolling Acres Rd Ste 1
Lady Lake, FL 32159-5037
Phone (352) 674-6300

Other identifiers 2

IdentifierTypeStateIssuer
061970100MedicaidFL
C12688OtherFLRR MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050509000103 FL Part B Supplier - Clinic/Group Practice 4789624826 Receives reassigned benefits from 2 practitioners
Practice locations: Lady Lake, FL

National Provider Directory

National Provider Directory

Locations

922 Rolling Acres Rd
Ste 1
Lady Lake, FL 32159
Phone (352) 674-6300

301 S Lake St
Leesburg, FL 34748
Phone (352) 326-2224

Practitioners & affiliated clinicians

Practitioners 10

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": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647302400000",
    "number": "1124014709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "922 ROLLING ACRES RD STE 1",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321595037",
            "telephone_number": "352-674-6300",
            "fax_number": "527-536-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "922 ROLLING ACRES RD STE 1",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321595037",
            "telephone_number": "352-674-6300",
            "fax_number": "353-753-6399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS FOR ACCOUNTABLE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-20",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A",
        "authorized_official_last_name": "GROHLER",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "352-674-6300"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "061970100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "C12688",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lady Lake, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; 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.