NPIMap

Organization Active NPI

Longwood Medical Group PA

  • Cardiovascular Disease Physician
  • Longwood, FL
National Provider Identifier
1235323023
Registry record updated May 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
ME78066 Issued in FL
Legal business name
LONGWOOD MEDICAL GROUP PA
Practice address
450 W State Road 434
Ste 301
Longwood, FL 32750-5187
Phone
(407) 767-8200
Fax
(407) 767-0476
NPI assigned
Sep 5, 2007
Reactivated
May 1, 2018
Last updated
May 1, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2018

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

Authorized official

Name
Ms. Alisa Marie Character
Title
Billing Office Supervisor
Phone
(407) 767-8200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME79324 FL
Cardiovascular Disease Physician 207RC0000X ME78066 FL Primary

Addresses

Primary practice location

450 W State Road 434
Ste 301
Longwood, FL 32750-5187

Mailing address

450 W State Rd 434
Ste 301
Longwood, FL 32750
Phone (407) 767-8200

Other names 1

  • Longwood Cardiology PA Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040305000618 FL Part B Supplier - Clinic/Group Practice 0941198519 Receives reassigned benefits from 15 practitioners
Practice locations: Oviedo, FL; Orlando, FL; Longwood, FL; Lake Mary, FL; Apopka, FL; Orange City, 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
10D1047086Longwood Cardiology450 W State Rd 434 Ste 301, Longwood, FL 32750Certificate of waiverOct 25, 2027

National Provider Directory

National Provider Directory

Locations

1349 S International Pkwy
Ste 1411
Lake Mary, FL 32746
Phone (407) 333-3360

450 W State Road 434
Ste 301
Longwood, FL 32750

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1577/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525132800000",
    "number": "1235323023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 W STATE RD 434",
            "address_2": "STE 301",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "32750",
            "telephone_number": "407-767-8200",
            "fax_number": "407-767-0476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 W STATE ROAD 434",
            "address_2": "STE 301",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327505187",
            "telephone_number": "407-767-8200",
            "fax_number": "407-767-0476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGWOOD MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2018-05-01",
        "deactivation_date": "2018-04-15",
        "reactivation_date": "2018-05-01",
        "status": "A",
        "authorized_official_last_name": "CHARACTER",
        "authorized_official_first_name": "ALISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "BILLING OFFICE SUPERVISOR",
        "authorized_official_telephone_number": "407-767-8200",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME79324",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME78066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Longwood Cardiology PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Longwood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2018; 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.