Family Medical Care of Mount Dora Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

HCC10266 Issued in FL

Legal business name

FAMILY MEDICAL CARE OF MOUNT DORA INC

Practice address

17580 US Highway 441
Mount Dora, FL 32757-6711

Phone

(352) 383-8200

NPI assigned

Jun 2, 2014

Organization subpart

No

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

Authorized official

Name

John N Boucher

Title

Ceo

Phone

(407) 834-7800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11827/brand/1/csg/1/fhir/r4

Practitioners 3

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

• William Frederick Von Bargen Jr., D.O.

  • Family Medicine Physician
  • Leesburg, FL
  • NPI 1851335038
  Medicare reassignment NPD
• Heather Marie Cedeno

  • Family Nurse Practitioner
  • Mount Dora, FL
  • NPI 1770445405
  Medicare reassignment NPD (past)
• Gina Elizabeth Hall-Ingalls, ARNP-C

  • Family Nurse Practitioner
  • Mount Dora, FL
  • NPI 1215983317
  Medicare reassignment

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

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422576000000",
    "number": "1265844757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1844",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327561844",
            "telephone_number": "352-383-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17580 US HIGHWAY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576711",
            "telephone_number": "352-383-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL CARE OF MOUNT DORA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-02",
        "last_updated": "2015-01-30",
        "status": "A",
        "authorized_official_last_name": "BOUCHER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "407-834-7800"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "HCC10266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jameila Evans
• Eye Specialists of Florida, PA
• Jessica Ezelle
• Leah Faircloth
• Kassie Virginia Falcon
• Hassan Farhat, MD
• Carlos Faviel Font, M.D.
• Brandy Feagan
• Yvonne Feavearyear, LMT
• Coralys Feliciano, RBT

• Family Medicine Physician in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.