Ellenton Family Practice Direct PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PA9102767 Issued in FL

Legal business name

ELLENTON FAMILY PRACTICE DIRECT PLLC

Practice address

907 25TH Dr E
Ellenton, FL 34222-2053

Phone

(941) 321-8299

NPI assigned

Jul 20, 2016

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. David Allan Hervig, PA-CNPI 1841221678

Title

Office Manage and Partner

Phone

(941) 730-5326

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

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13889/brand/1/csg/1/fhir/r4

Practitioners 4

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.

• David Hervig, PA-C

  • Physician Assistant
  • Bradenton, FL
  • NPI 1841221678
  Medicare reassignment Authorized official
• Stephanie Marie Arreola, RN, ARNP, AGPCNP-C

  • Nurse Practitioner
  • Parrish, FL
  • NPI 1194359554
  Medicare reassignment NPD
• Raphael Kulawik, D.O.

  • Family Medicine Physician
  • Bradenton, FL
  • NPI 1114238250
  Medicare reassignment NPD
• Lauren S Swanson, APRN FNP-C

  • Family Nurse Practitioner
  • Lakewood Ranch, FL
  • NPI 1952273419

  Single Specialty

  NPD

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

{
    "created_epoch": "1468972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1124471503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 25TH DR E",
            "city": "ELLENTON",
            "state": "FL",
            "postal_code": "342222053",
            "telephone_number": "941-417-7386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 25TH DR E",
            "city": "ELLENTON",
            "state": "FL",
            "postal_code": "342222053",
            "telephone_number": "941-321-8299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLENTON FAMILY PRACTICE DIRECT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-20",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "HERVIG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "OFFICE MANAGE AND PARTNER",
        "authorized_official_telephone_number": "941-730-5326",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "PA9102767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dr. Tre Thomas, Psychologist, PLLC
• Elite Integrated Medical Centers
• Ellenton Family Dental Corp
• Ellenton Pediatrics PA
• Em Legacy LLC
• Rebecca L Emmett, DPT
• Excel Pain and Spine LLC
• Faipler Chiropractic LLC

• Family Medicine Physician in Ellenton, FL
• Providers in Ellenton, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.