Organization Active NPI

Lifestream Family Medicine P.a.

  • Family Medicine Physician
  • Bradenton, FL
National Provider Identifier
1265075261
Registry record updated Jul 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LIFESTREAM FAMILY MEDICINE P.A.
Practice address
1957 Worth Court
Bradenton, FL 34211
Phone
(941) 755-0433
NPI assigned
Oct 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2020

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

Authorized official

Name
Saska Fiona Sookra Winslow, M.D.NPI 1730269556
Title
Ceo/Owner
Phone
(941) 755-0433

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1957 Worth Court
Bradenton, FL 34211

Mailing address

1957 Worth Court
Bradenton, FL 34211
Phone (941) 755-0433

Other identifiers 1

IdentifierTypeStateIssuer
ME96301OtherFLMEDICAL LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200423002249 FL Part B Supplier - Clinic/Group Practice 2264862721 Receives reassigned benefits from 1 practitioner
Practice locations: Bradenton, 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
10D2179640Lifestream Family Medicine1957 Worth CT, Bradenton, FL 34211Certificate of waiverFeb 26, 2028

National Provider Directory

National Provider Directory

Locations

1957 Worth Ct
Bradenton, FL 34211
Phone (941) 755-0433

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1571702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594339200000",
    "number": "1265075261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1957 WORTH COURT",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "34211",
            "telephone_number": "941-755-0433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1957 WORTH COURT",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "34211",
            "telephone_number": "941-755-0433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTREAM FAMILY MEDICINE P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-22",
        "last_updated": "2020-07-10",
        "certification_date": "2020-07-10",
        "status": "A",
        "authorized_official_last_name": "SOOKRA WINSLOW",
        "authorized_official_first_name": "SASKA",
        "authorized_official_middle_name": "FIONA",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "941-755-0433",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME96301",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; 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.