NPIMap

Organization Active NPI

Port Charlotte Hma Physician Management LLC

Doing business as Comprehensive Women's Health Care of Arcadia

  • Obstetrics & Gynecology Physician
  • Arcadia, FL
National Provider Identifier
1124697743
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
Doing business as
Comprehensive Women's Health Care of Arcadia
Port Charlotte HMA Physician Management LLC
Practice address
1012 N Mills Ave
Arcadia, FL 34266-8811
Phone
(941) 766-0400
Fax
(941) 766-1009
NPI assigned
Jun 18, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2022

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

Authorized official

Name
Jennifer L Jackson
Title
Sr Dir Prov Enrollment & Onboarding
Phone
(615) 465-3334

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207V00000X Primary
Obstetrics & Gynecology Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LX0001X

Addresses

Primary practice location

1012 N Mills Ave
Arcadia, FL 34266-8811

Mailing address

1012 N Mills Ave
Arcadia, FL 34266-8811
Phone (615) 465-7211

Other identifiers 1

IdentifierTypeStateIssuer
102610201MedicaidFL

Other names 2

  • COMPREHENSIVE WOMEN'S HEALTH CARE OF ARCADIA Doing business as
  • Port Charlotte HMA Physician Management LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Port Charlotte Hma Physician Management LLC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1623974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1124697743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 N MILLS AVE",
            "city": "ARCADIA",
            "state": "FL",
            "postal_code": "342668811",
            "telephone_number": "615-465-7211",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 N MILLS AVE",
            "city": "ARCADIA",
            "state": "FL",
            "postal_code": "342668811",
            "telephone_number": "941-766-0400",
            "fax_number": "941-766-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-18",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR DIR PROV ENROLLMENT & ONBOARDING",
        "authorized_official_telephone_number": "615-465-3334"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102610201",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COMPREHENSIVE WOMEN'S HEALTH CARE OF ARCADIA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Port Charlotte HMA Physician Management LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Port Charlotte HMA Physician Management LLC",
            "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 Mar 16, 2022; 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.