NPIMap

Organization Active NPI

Lake Mary Spine & Rehabilitation Center

  • Clinic/Center
  • Sanford, FL
National Provider Identifier
1154724441
Registry record updated Oct 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
CH 10784 Issued in FL
Legal business name
LAKE MARY SPINE & REHABILITATION CENTER
Practice address
820 W Lake Mary Blvd
107
Sanford, FL 32773-5946
Phone
(407) 942-3258
Fax
(407) 942-3316
NPI assigned
Oct 1, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2014

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

Authorized official

Name
Yanina Genao, D.C.NPI 1013251032
Title
Chiropractor
Phone
(407) 942-3258

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
Clinic/Center 261Q00000X CH 10784 FL Primary

Addresses

Primary practice location

820 W Lake Mary Blvd
107
Sanford, FL 32773-5946

Mailing address

820 W Lake Mary Blvd
107
Sanford, FL 32773-5946
Phone (407) 942-3258

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150127001203 FL Part B Supplier - Clinic/Group Practice 6507180379 Receives reassigned benefits from 3 practitioners
Practice locations: Davenport, FL; Orlando, FL; Sanford, FL

National Provider Directory

National Provider Directory
Tax ID family
Lee Vista Chiropractic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

45677 Highway 27
Davenport, FL 33897
Phone (407) 942-3258

2222 S Kirkman Rd
Orlando, FL 32811
Phone (407) 802-4476

111 E Lake Mary Blvd
Ste 115
Sanford, FL 32773
Phone (407) 942-3258

115 E Lake Mary Blvd
Sanford, FL 32773
Phone (407) 942-3258

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1412121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412121600000",
    "number": "1154724441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 W LAKE MARY BLVD",
            "address_2": "107",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327735946",
            "telephone_number": "407-942-3258",
            "fax_number": "407-942-3316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 W LAKE MARY BLVD",
            "address_2": "107",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327735946",
            "telephone_number": "407-942-3258",
            "fax_number": "407-942-3316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MARY SPINE & REHABILITATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-01",
        "last_updated": "2014-10-01",
        "status": "A",
        "authorized_official_last_name": "GENAO",
        "authorized_official_first_name": "YANINA",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "407-942-3258",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "CH 10784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sanford, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.