Extended Care Medical Services LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EXTENDED CARE MEDICAL SERVICES LLC

Practice address

1730 E Hwy 50
PMB 4
Clermont, FL 34711-2778

Phone

(352) 408-5955

Fax

(352) 536-8141

NPI assigned

Jul 15, 2011

Last updated

Jul 15, 2011By 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

Andrea M Macdonald, ARNP

Title

Owner

Phone

(352) 536-8140

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1310688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310688000000",
    "number": "1184912818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 E HWY 50",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347112778",
            "telephone_number": "352-408-5955",
            "fax_number": "352-536-8141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 E HWY 50",
            "address_2": "PMB 4",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347112778",
            "telephone_number": "352-408-5955",
            "fax_number": "352-536-8141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDED CARE MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-15",
        "last_updated": "2011-07-15",
        "status": "A",
        "authorized_official_last_name": "MACDONALD",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-536-8140",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "305309100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2011; 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.