Health & Wellcare Services of Florida, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME0048978 Issued in FL

Legal business name

HEALTH & WELLCARE SERVICES OF FLORIDA, INC.

Practice address

5915 W Gulf to Lake Hwy
Crystal River, FL 34429-7565

Phone

(352) 794-3872

Fax

(352) 794-3876

NPI assigned

Jan 26, 2007

Last updated

Nov 14, 2012By 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

Johnnie R Degraw, M.D

Title

President

Phone

(352) 794-3872

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352851200000",
    "number": "1144376658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5915 W GULF TO LAKE HWY",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344297565",
            "telephone_number": "352-794-3872",
            "fax_number": "352-794-3876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5915 W GULF TO LAKE HWY",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344297565",
            "telephone_number": "352-794-3872",
            "fax_number": "352-794-3876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH & WELLCARE SERVICES OF FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2012-11-14",
        "status": "A",
        "authorized_official_last_name": "DEGRAW",
        "authorized_official_first_name": "JOHNNIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-794-3872",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0048978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OSCAR",
            "identifier": "108911",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002711800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Crystal River, FL
• Providers in Crystal River, 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 Nov 14, 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.