Family Care Medical Center II LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

FAMILY CARE MEDICAL CENTER II LLC

Doing business as

Family Care Medical Center

Practice address

819 N Mills Ave
Arcadia, FL 34266-8716

Phone

(863) 491-2277

Fax

(863) 491-3077

NPI assigned

Jul 7, 2021

Last updated

Jul 21, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

FAMILY CARE MEDICAL CENTER II LLCAs reported in NPPES

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

Authorized official

Name

Kenan Murat Cetin, PANPI 1801864954

Title

Owner

Phone

(863) 491-2277

Specialties & licenses 1

Addresses

Other names 1

• Family Care Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225609597. Details of each certification follow.

• CCN 683838 Rural health clinic · Active · Details

Rural health clinic certification: CCN 683838

Legal name

FAMILY CARE MEDICAL CENTER II LLC

Doing business as

FAMILY CARE MEDICAL CENTER

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

May 19, 2021

Last certification

May 19, 2021

Ownership / control type

1B

Organization structure

LLCProprietary

Enrollment address

819 N Mills Ave
Ste B&C
Arcadia, FL 34266-8716

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Family Care Medical Center II LLC

  dba Family Care Medical Center

  • Family Medicine Physician
  • Arcadia, FL
  • NPI 1114514809

  4587077409

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Family Care Medical Center II LLC

  dba Family Care Medical Center

  • Family Medicine Physician
  • Arcadia, FL
  • NPI 1114514809

  O20210113001197, O20210310000010

  Same enrollment

Part of

Family Care Medical Center

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Kenan Murat Cetin, PA-C MBA

  • Medical Physician Assistant
  • Arcadia, FL
  • NPI 1801864954

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership
• Achilles Kalnoky, M.D.

  • Family Medicine Physician
  • Sarasota, FL
  • NPI 1245460690

  Contracted Managing Employee, Corporate Director

  CMS ownership

Practitioners 3

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.

• Kenan Murat Cetin, PA-C MBA

  • Medical Physician Assistant
  • Arcadia, FL
  • NPI 1801864954
  NPD Authorized official
• Deberly M Anzueto, PA

  • Physician Assistant
  • Arcadia, FL
  • NPI 1578277877
  NPD
• Achilles Kalnoky, M.D.

  • Family Medicine Physician
  • Sarasota, FL
  • NPI 1245460690
  NPD

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

{
    "created_epoch": "1625616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626825600000",
    "number": "1225609597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 N MILLS AVE",
            "city": "ARCADIA",
            "state": "FL",
            "postal_code": "342668716",
            "telephone_number": "863-491-2277",
            "fax_number": "863-491-3077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 N MILLS AVE",
            "city": "ARCADIA",
            "state": "FL",
            "postal_code": "342668716",
            "telephone_number": "863-491-2277",
            "fax_number": "863-491-3077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE MEDICAL CENTER II LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY CARE MEDICAL CENTER II LLC",
        "enumeration_date": "2021-07-07",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A",
        "authorized_official_last_name": "CETIN",
        "authorized_official_first_name": "KENAN",
        "authorized_official_middle_name": "MURAT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-491-2277",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Care Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Care Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lenora Juanita Enix, PSY.D.
• Erica Escamilla, APRN
• Kyle L Fairchild, ARNP
• Johari Patrice Faison, PMHNP-BC
• Family Care Medical Center II LLC (Family Care Medical Center)
• Deborah J Fantin, DO
• Deanna Lynn Feher, LCSW
• Jessica Alexandra Fennell-Thomas, APRN
• John Fernandez, PT
• Juan Carlos Fernandez, APRN

• Rural Health Clinic/Center in Arcadia, FL
• Providers in Arcadia, FL by specialty
• Rural Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.