Sun State Prosthetics Inc.

Primary specialty

ProsthetistTaxonomy code 224P00000X

License

PRO 12 Issued in FL

Legal business name

SUN STATE PROSTHETICS INC.

Practice address

1444 W Fairbanks Ave
Winter Park, FL 32789-4806

Phone

(407) 629-2866

Fax

(407) 629-4277

NPI assigned

Jul 16, 2006

Last updated

Sep 15, 2016By 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

Mr. Charles Frederick Gano, L.C.P.

Title

Owner

Phone

(407) 629-2866

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

Medicare medical equipment & supply locations

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Sun State Prosthetics Inc

  • Prosthetist
  • Daytona Beach, FL
  • NPI 1194843797
  NPPES parent name

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473897600000",
    "number": "1215954045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1444 W FAIRBANKS AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894806",
            "telephone_number": "407-629-2866",
            "fax_number": "407-629-4277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1444 W FAIRBANKS AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894806",
            "telephone_number": "407-629-2866",
            "fax_number": "407-629-4277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN STATE PROSTHETICS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2016-09-15",
        "status": "A",
        "authorized_official_last_name": "GANO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "FREDERICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-629-2866",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.C.P."
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Prosthetist",
            "state": "FL",
            "license": "PRO 12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "0662480001",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacqueline P Sullivan, M.A.,CCC/SLP
• Summer Time Alf, Inc.
• Summer Time Lodge, Inc.
• Summit Behavioral Healthcare Associates, Inc.
• Sun Care Medical Supply of Central Florida
• Chenzhe Sun
• Surgan Medical Management
• Surgical Associates of Central Florida PA (Surgical Associates)
• Surgical Center Associates LTD (Winter Park Ambulatory Surgical Center)
• Surgical Group of Winter Park LLC

• Prosthetist in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Prosthetist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2016; 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.