Jupiter Lakes Physician Group PA

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

JUPITER LAKES PHYSICIAN GROUP PA

Practice address

210 Jupiter Lakes Blvd Ste 4104
Jupiter, FL 33458-7190

Phone

(561) 744-3467

Fax

(561) 748-3272

NPI assigned

Dec 16, 2019

Last updated

Dec 16, 2019By 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

Michelle Fuller

Title

Administrator

Phone

(561) 398-3661

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 5

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.

• Leslie Erlinda Diaz, MD

  • Infectious Disease Physician
  • North Palm Beach, FL
  • NPI 1750342689
  Medicare reassignment NPD
• Lorraine Marshall

  • Family Nurse Practitioner
  • Lauderhill, FL
  • NPI 1962884874
  Medicare reassignment NPD
• Claudia Salgado Lugo

  • Family Nurse Practitioner
  • Jupiter, FL
  • NPI 1467209262
  Medicare reassignment NPD
• Jose Stable, MD

  • Internal Medicine Physician
  • Jupiter, FL
  • NPI 1851346605
  NPD
• Baqir M Syed, MD

  • Internal Medicine Physician
  • Lake Worth, FL
  • NPI 1881678464
  NPD

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

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576454400000",
    "number": "1154969699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 JUPITER LAKES BLVD STE 4104",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334587190",
            "telephone_number": "561-744-3467",
            "fax_number": "561-748-3272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 JUPITER LAKES BLVD STE 4104",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334587190",
            "telephone_number": "561-744-3467",
            "fax_number": "561-748-3272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUPITER LAKES PHYSICIAN GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-16",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "561-398-3661"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jupiter Imaging Associates Inc
• Jupiter Infusion LLC
• Jupiter Internal Medicine Associates P a
• Jupiter Internal Medicine Group LLC
• Jupiter Kidney Center LLC
• Jupiter Laser and Regenerative Medicine LLC
• Jupiter Medical Center Pavilion Inc
• Jupiter Medical Center Pavilion, Inc. (Lighthouse Detox)
• Jupiter Medical Center Physician Group
• Jupiter Medical Center Physicians Group (Jupiter Medical Center Urgent Care)

• Primary Care Clinic/Center in Jupiter, FL
• Providers in Jupiter, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2019; 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.