NPIMap

Organization Active NPI

Healthstat Wellness-Polk Haines

  • Preventive Medicine/Occupational Environmental Medicine Physician
  • Haines City, FL
National Provider Identifier
1134495245
Registry record updated Jul 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preventive Medicine/Occupational Environmental Medicine PhysicianTaxonomy code 2083P0500X
Legal business name
HEALTHSTAT WELLNESS-POLK HAINES
Practice address
631B US Highway 17 92 W
Haines City, FL 33844-5047
Phone
(863) 519-3858
NPI assigned
Mar 23, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2020

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

Authorized official

Name
Jill Johnson Patton
Title
Director of Risk Management
Phone
(704) 936-5546

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Preventive Medicine/Occupational Environmental Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2083P0500X Primary
Clinic Pharmacy 3336C0002X

Addresses

Primary practice location

631B US Highway 17 92 W
Haines City, FL 33844-5047

Mailing address

4601 Charlotte Park Dr
Suite 390
Charlotte, NC 28217-1915
Phone (704) 529-6161

Other identifiers 1

IdentifierTypeStateIssuer
5709730OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Healthstat On-Site Clinic/Polk County Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Healthstat on-Site Clinicmilliken Kex237 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 10

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

631B US Highway 17 92 W
Haines City, FL 33844
Phone (705) 661-1380

4601 Charlotte Park Dr
Ste 390
Charlotte, NC 28217

NPI Registry JSON

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

{
    "created_epoch": "1332460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594684800000",
    "number": "1134495245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 CHARLOTTE PARK DR",
            "address_2": "SUITE 390",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282171915",
            "telephone_number": "704-529-6161",
            "fax_number": "704-936-5570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631B US HIGHWAY 17 92 W",
            "city": "HAINES CITY",
            "state": "FL",
            "postal_code": "338445047",
            "telephone_number": "863-519-3858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSTAT WELLNESS-POLK HAINES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-23",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A",
        "authorized_official_last_name": "PATTON",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "JOHNSON",
        "authorized_official_title_or_position": "DIRECTOR OF RISK MANAGEMENT",
        "authorized_official_telephone_number": "704-936-5546"
    },
    "taxonomies": [
        {
            "code": "2083P0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5709730",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthstat On-Site Clinic/Polk County",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Healthstat On-Site Clinic/Polk County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Haines City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; 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.