NPIMap

Organization Active NPI

Lisa Rankin MD PA

  • Family Medicine Physician
  • Port St Lucie, FL
National Provider Identifier
1124292867
Registry record updated Jan 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME0074325 Issued in FL
Legal business name
LISA RANKIN MD PA
Practice address
499 NW Prima Vista Blvd
Suite 105
Port St Lucie, FL 34983-8786
Phone
(772) 344-1409
Fax
(772) 344-9441
NPI assigned
Apr 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2012

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

Authorized official

Name
Dr. Lisa M Rankin, M.D., P.A.NPI 1720012438
Title
Owner/Agent
Phone
(772) 344-1409

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X ME0074325 FL Primary

Addresses

Primary practice location

499 NW Prima Vista Blvd
Suite 105
Port St Lucie, FL 34983-8786

Mailing address

499 NW Prima Vista Blvd
Suite 105
Port St Lucie, FL 34983-8786
Phone (772) 344-1409

Other identifiers 1

IdentifierTypeStateIssuer
253926800MedicaidFL

Other names 1

  • Coastal Integrative Medicine Doing business as

National Provider Directory

National Provider Directory

Locations

497 NW Prima Vis Blvd
Ste 105
Port St Lucie, FL 34983
Phone (772) 344-1409

499 NW Prima Vista Blvd
Unit 105
Port St Lucie, FL 34983
Phone (772) 344-1409

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327363200000",
    "number": "1124292867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "499 NW PRIMA VISTA BLVD",
            "address_2": "SUITE 105",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349838786",
            "telephone_number": "772-344-1409",
            "fax_number": "772-344-9441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 NW PRIMA VISTA BLVD",
            "address_2": "SUITE 105",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349838786",
            "telephone_number": "772-344-1409",
            "fax_number": "772-344-9441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA RANKIN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2012-01-24",
        "status": "A",
        "authorized_official_last_name": "RANKIN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/AGENT",
        "authorized_official_telephone_number": "772-344-1409",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., P.A."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0074325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253926800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Integrative Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.