Dr Phillips Medical Wellness Center LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

DR PHILLIPS MEDICAL WELLNESS CENTER LLC

Practice address

2915 Lakeview Dr Ste 1001
Fern Park, FL 32730-2009

Phone

(407) 900-0613

Fax

(407) 335-6945

NPI assigned

Oct 12, 2017

Last updated

Mar 25, 2021By 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

Dr. Maryam Phillips, MDNPI 1447578372

Title

Owner

Phone

(407) 900-0613

Specialties & licenses 1

Addresses

Other identifiers 1

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

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17107/brand/1/csg/1/fhir/r4

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Maryam Phillips, M.D.

  • Family Medicine Physician
  • Altamonte Springs, FL
  • NPI 1447578372
  Authorized official Same address or phone
• Charles Edward Dorfman, MD

  • Urology Physician
  • Apopka, FL
  • NPI 1144438748
  NPD (past)

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

{
    "created_epoch": "1507766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616630400000",
    "number": "1225549603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 S FISKE BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554306",
            "telephone_number": "407-960-1465",
            "fax_number": "407-335-6945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2915 LAKEVIEW DR STE 1001",
            "city": "FERN PARK",
            "state": "FL",
            "postal_code": "327302009",
            "telephone_number": "407-900-0613",
            "fax_number": "407-335-6945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR PHILLIPS MEDICAL WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-12",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "MARYAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-900-0613",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL MEDICARE",
            "identifier": "NH873",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Complete Health and Wellness Clinic, LLC
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• Christian Danforth
• Cynthia Daniels
• Alejandro Diaz de Villegas
• Afsoon Elmore, DDS
• Julie Emmer, LCSW
• Amanda English
• Estapona Operating, LLC (Strive at Fern Park)
• Eye Express, Inc

• Family Medicine Physician in Fern Park, FL
• Providers in Fern Park, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; 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.