NPIMap

Organization Active NPI

Primary Care Medical Services of Poinciana Inc

  • Federally Qualified Health Center (FQHC)
  • Kissimmee, FL
National Provider Identifier
1144733031
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY CARE MEDICAL SERVICES OF POINCIANA INC
Doing business as
Osceola Community Health Services @ BVL
Practice address
2622 Simpson Rd
Kissimmee, FL 34744-4674
Phone
(407) 943-8600
NPI assigned
Nov 14, 2017
Organization subpart
Yes
Parent organization
PRIMARY CARE MEDICAL SERVICES OF POINCIANA INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Authorized official

Name
Belinda Johnson-Cornett
Title
Ceo
Phone
(407) 943-8600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2622 Simpson Rd
Kissimmee, FL 34744-4674

Mailing address

1503 Bill Beck Blvd
Kissimmee, FL 34744-9516
Phone (407) 943-8600

Other names 1

  • Osceola Community Health Services @ BVL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180523000310 FL Part A Provider - Federally Qualified Health Center (FQHC) 4486923059 Practice locations: Kissimmee, FL

Federally qualified health center certification: CCN 681125

Legal name
PRIMARY CARE MEDICAL SERVICES OF POINCIANA INC
Doing business as
OSCEOLA COMMUNITY HEALTH SERVICES IN BVL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 23, 2018
Last certification
May 23, 2018
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 2017 in FL
Enrollment address
2622 Simpson Rd
Kissimmee, FL 34744-4674

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Primary Care Medical Services of Poinciana Inc13 organizations share this tax ID, including this one
Part of
Primary Care Medical Services of Poinciana Inc

Other organizations with this tax ID 12

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

Locations

1875 Fortune Rd
Bldg 2
Kissimmee, FL 34744

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Cynthia Diaz Individual Corporate OfficerCfo Jan 1, 2021
W-2 Managing Employee Sep 6, 2017
Magaly Guzman Individual W-2 Managing EmployeeAdministrative Assistant Apr 1, 2017
Primary Care Medical Services of Poinciana Inc Organization, Kissimmee, FL Non-profit Operational/Managerial Control Apr 1, 2017 100%
Sally Sera Individual Corporate DirectorBoard Member Apr 1, 2017
Belinda Johnson Cornett Individual Corporate OfficerCeo Apr 1, 2017

Owners & managing parties with NPI records 9

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Osceola Community Health Services at Cameron PreserveKissimmee, FL, CCN 101018 Federally qualified health center Operational/Managerial Control Sep 30, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1510617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1144733031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 BILL BECK BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347449516",
            "telephone_number": "407-943-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2622 SIMPSON RD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347444674",
            "telephone_number": "407-943-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE MEDICAL SERVICES OF POINCIANA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMARY CARE MEDICAL SERVICES OF POINCIANA INC",
        "enumeration_date": "2017-11-14",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-CORNETT",
        "authorized_official_first_name": "BELINDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "407-943-8600"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Osceola Community Health Services @ BVL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.