Lake Mary Family Physicians P.a.

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

ME88467, ME88578 Issued in FL

Legal business name

LAKE MARY FAMILY PHYSICIANS P.A.

Practice address

910 Williston Park PT
Suite 2050
Lake Mary, FL 32746-2172

Phone

(407) 829-8960

Fax

(407) 829-8978

NPI assigned

Sep 25, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Leah M Sutphin

Title

Billing Manager

Phone

(407) 829-8960

Specialties & licenses 2

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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

• Aleksandra Clayton, MD

  • Family Medicine Physician
  • Winter Park, FL
  • NPI 1801225115
  NPD (past)
• Michelle Ann Cooley, ARNP

  • Family Nurse Practitioner
  • Lake Mary, FL
  • NPI 1316120504
  NPD (past)
• Stacey E. Pickering, ARNP

  • Urology Physician
  • Lake Mary, FL
  • NPI 1265429518
  NPD (past)

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

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246924800000",
    "number": "1174719082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 WILLISTON PARK PT",
            "address_2": "SUITE 2050",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462172",
            "telephone_number": "407-829-8960",
            "fax_number": "407-829-8978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 WILLISTON PARK PT",
            "address_2": "SUITE 2050",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462172",
            "telephone_number": "407-829-8960",
            "fax_number": "407-829-8978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MARY FAMILY PHYSICIANS P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2009-07-07",
        "status": "A",
        "authorized_official_last_name": "SUTPHIN",
        "authorized_official_first_name": "LEAH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "407-829-8960",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "FL",
            "license": "ME88467, ME88578",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP1103432",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "94986",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "K8696",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake Mary Chiropractic Center PA
• Lake Mary Counseling
• Lake Mary Dental PA
• Lake Mary Family Care P a
• Lake Mary Family Medicine, Inc.
• Lake Mary Health Care Associates LLC
• Lake Mary Imaging Center, Inc.
• Lake Mary Infusion Center
• Lake Mary Medical Center
• Lake Mary Medical Services, LLC

• Exclusive Provider Organization in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Exclusive Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.