NPIMap

Organization Active NPI

Collier Hma Physician Management LLC

  • Pain Medicine Physician
  • Estero, FL
National Provider Identifier
1164090874
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
COLLIER HMA PHYSICIAN MANAGEMENT LLC
Practice address
24231 Walden Center Dr Ste 201
Estero, FL 34134-5012
Phone
(239) 348-4420
Fax
(239) 390-2486
NPI assigned
Jun 17, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

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

Authorized official

Name
Jennifer L Jackson
Title
Sr Dir Prov Enrollment & Onboarding
Phone
(615) 465-3334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208VP0000X Primary

Addresses

Primary practice location

24231 Walden Center Dr Ste 201
Estero, FL 34134-5012

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-7211

Other identifiers 1

IdentifierTypeStateIssuer
275883117MedicaidFL

Other names 2

  • Collier HMA Physician Management LLC Doing business as
  • Physicians Regional Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Collier Hma Physician Management LLC37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1164090874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-7211",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24231 WALDEN CENTER DR STE 201",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "341345012",
            "telephone_number": "239-348-4420",
            "fax_number": "239-390-2486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIER HMA PHYSICIAN MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-17",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR DIR PROV ENROLLMENT & ONBOARDING",
        "authorized_official_telephone_number": "615-465-3334"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275883117",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collier HMA Physician Management LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Physicians Regional Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Physicians Regional Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Estero, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.