Active NPI
Gertrude Dorman
- Assisted Living Facility
- Port Charlotte, FL
National Provider Identifier
1235890559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- Practice address
- 21936 Beverly Ave
Port Charlotte, FL 33952-5429 - Phone
- (941) 467-2665
- NPI assigned
- Jan 8, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | Primary |
Addresses
Primary practice location
21936 Beverly Ave
Port Charlotte, FL 33952-5429
Mailing address
21936 Beverly Ave
Port Charlotte, FL 33952-5429
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 87-3948492 | Other | FL | TAX IDENTIFICATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641600000000",
"number": "1235890559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21936 BEVERLY AVE",
"city": "PORT CHARLOTTE",
"state": "FL",
"postal_code": "339525429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21936 BEVERLY AVE",
"city": "PORT CHARLOTTE",
"state": "FL",
"postal_code": "339525429",
"telephone_number": "941-467-2665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORMAN",
"first_name": "GERTRUDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-08",
"last_updated": "2022-01-08",
"certification_date": "2022-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX IDENTIFICATION",
"identifier": "87-3948492",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Charlotte, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.