Jupiter Lakes Physician Group PA

Key facts

NPI

1154969699

Entity type

Organization (NPI type 2)

Primary specialty

Primary Care Clinic/Center 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

Organization subpart

No

Authorized official

Name

Michelle Fuller

Title

Administrator

Phone

(561) 398-3661

Practitioners 5

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

• Leslie Erlinda Diaz, MD Infectious Disease Physician · North Palm Beach, FL · NPI 1750342689
  Medicare reassignment NPD FL
• Lorraine Marshall Family Nurse Practitioner · Lauderhill, FL · NPI 1962884874
  Medicare reassignment NPD FL
• Claudia Salgado Lugo Family Nurse Practitioner · Jupiter, FL · NPI 1467209262
  Medicare reassignment NPD FL
• Jose Stable, MD Internal Medicine Physician · Jupiter, FL · NPI 1851346605
  NPD
• Baqir M Syed, MD Internal Medicine Physician · Lake Worth, FL · NPI 1881678464
  NPD

Medicare participation

Medicare fee-for-service enrollment

Enrolled in FL

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 16, 2019.

{
    "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": []
}

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All providers in Jupiter, FL · Primary Care Clinic/Center in Florida