NPIMap

Organization Active NPI

Port Charlotte Hma Physician Management LLC

Doing business as Bayfront Health Wound Care and Hyperbaric Center

  • Family Medicine Physician
  • Punta Gorda, FL
National Provider Identifier
1265003537
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
Doing business as
Bayfront Health Wound Care and Hyperbaric Center
Port Charlotte HMA Physician Management LLC
Practice address
25097 Olympia Ave Ste 107
Punta Gorda, FL 33950-3914
Phone
(941) 205-2620
Fax
(941) 235-2347
NPI assigned
Jul 7, 2021
Last updated
Mar 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2022

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

Authorized official

Name
Jennifer L Jackson
Title
Sr Dir Prov Enrollment & Onboarding
Phone
(615) 465-3334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

25097 Olympia Ave Ste 107
Punta Gorda, FL 33950-3914

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-7211

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidFL

Other names 2

  • Bayfront Health Wound Care and Hyperbaric Center Doing business as
  • Port Charlotte HMA Physician Management LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Port Charlotte Hma Physician MGMT LLC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

25097 Olympia Ave
Ste 107
Punta Gorda, FL 33950
Phone (941) 205-2620

NPI Registry JSON

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

{
    "created_epoch": "1625616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1265003537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-7211",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25097 OLYMPIA AVE STE 107",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339503914",
            "telephone_number": "941-205-2620",
            "fax_number": "941-235-2347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-07",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR DIR PROV ENROLLMENT & ONBOARDING",
        "authorized_official_telephone_number": "615-465-3334"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bayfront Health Wound Care and Hyperbaric Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Port Charlotte HMA Physician Management LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Port Charlotte HMA Physician Management LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Punta Gorda, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.

Verify at the official NPI Registry.