Organization Active NPI

Comprehensive Health Center of Orlando, LLC

  • Family Medicine Physician
  • Orlando, FL
National Provider Identifier
1205361508
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS04440 Issued in FL
Legal business name
COMPREHENSIVE HEALTH CENTER OF ORLANDO, LLC
Practice address
1011 W Oak Ridge Rd
Orlando, FL 32809-4765
Phone
(407) 859-8797
Fax
(407) 859-8798
NPI assigned
Apr 24, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

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

Authorized official

Name
Mrs. Mary Ballantine
Title
Practice Manager-Certified
Phone
(305) 688-4178

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X OS04440 FL Primary

Addresses

Primary practice location

1011 W Oak Ridge Rd
Orlando, FL 32809-4765

Mailing address

1011 W Oak Ridge Rd
Orlando, FL 32809-4765
Phone (407) 859-8797

Other names 1

  • COMPREHENSIVE HEALTH CENTER Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171009001121 FL Part B Supplier - Clinic/Group Practice 5890060420 Receives reassigned benefits from 2 practitioners
Practice locations: Orlando, FL

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2140001Comprehensive Health Center of Orlando1011 W Oak Ridge Road, Orlando, FL 32809Certificate of waiverNov 13, 2027

National Provider Directory

National Provider Directory

Locations

655 NW 119th St
North Miami, FL 33168
Phone (305) 403-2219

1011 W Oak Ridge Rd
Orlando, FL 32809
Phone (407) 859-8797

1112 W Oak Ridge Rd
Orlando, FL 32809

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24158/brand/2/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1492992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717372800000",
    "number": "1205361508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 W OAK RIDGE RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328094765",
            "telephone_number": "407-859-8797",
            "fax_number": "407-859-8798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 W OAK RIDGE RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328094765",
            "telephone_number": "407-859-8797",
            "fax_number": "407-859-8798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE HEALTH CENTER OF ORLANDO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-24",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A",
        "authorized_official_last_name": "BALLANTINE",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "PRACTICE MANAGER-CERTIFIED",
        "authorized_official_telephone_number": "305-688-4178",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS04440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COMPREHENSIVE HEALTH CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.