NPIMap

Organization Active NPI

Sun 'N Lake Medical Group,PA

  • Rural Health Clinic/Center
  • Lake Placid, FL
National Provider Identifier
1144400540
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
ME61030 Issued in FL
Legal business name
SUN 'N LAKE MEDICAL GROUP,PA
Practice address
511 W Interlake Blvd
Lake Placid, FL 33852-0703
Phone
(863) 699-1220
Fax
(863) 699-1811
NPI assigned
Nov 14, 2007
Last updated
Oct 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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

Authorized official

Name
Dr. Raisa CamiloNPI 1427048495
Title
Owner
Phone
(863) 385-2659

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
Rural Health Clinic/Center 261QR1300X ME61030 FL Primary

Addresses

Primary practice location

511 W Interlake Blvd
Lake Placid, FL 33852-0703

Mailing address

511 W Interlake Blvd
Lake Placid, FL 33852-0703
Phone (863) 699-1220

Other identifiers 5

IdentifierTypeStateIssuer
23511OtherFLBCBS
373302500MedicaidFL
ME61030OtherFLMEDICAL LICENSE
160064OtherFLHEALTHESE
220402OtherFLHEALTHESE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080909000441 FL Part A Provider - Rural Health Clinic 2668380841 Practice locations: Lake Placid, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144400540. Details of each certification follow.

Rural health clinic certification: CCN 108999

Legal name
SUN 'N LAKE MEDICAL GROUP,PA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 31, 2008
Last certification
Jun 6, 2019
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Oct 9, 2000 in FL
Enrollment address
511 W Interlake Blvd
Lake Placid, FL 33852-0703

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1018920Sun N Lake Medical Group511 W Interlake Blvd, Lake Placid, FL 33852Certificate of waiverNov 4, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Miguel Francisco Beltre Individual 5% Or Greater Direct Ownership Interest Oct 1, 2000 50%
Raisa Camilo Individual 5% Or Greater Direct Ownership Interest Nov 13, 2007
Suzanne Cornuet Individual W-2 Managing EmployeeOffice Manager Mar 26, 2018 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761004800000",
    "number": "1144400540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 W INTERLAKE BLVD",
            "city": "LAKE PLACID",
            "state": "FL",
            "postal_code": "338520703",
            "telephone_number": "863-699-1220",
            "fax_number": "863-699-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 W INTERLAKE BLVD",
            "city": "LAKE PLACID",
            "state": "FL",
            "postal_code": "338520703",
            "telephone_number": "863-699-1220",
            "fax_number": "863-699-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN 'N LAKE MEDICAL GROUP,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-14",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A",
        "authorized_official_last_name": "CAMILO",
        "authorized_official_first_name": "RAISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-385-2659",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "ME61030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "23511",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "373302500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME61030",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHESE",
            "identifier": "160064",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHESE",
            "identifier": "220402",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Placid, FL

Sources for this page

Verify at the official NPI Registry.