Countryside Medical PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

COUNTRYSIDE MEDICAL PA

Practice address

7860 SW 103Rd Street Rd
BLDG 100 Suite 101
Ocala, FL 34476-8623

Phone

(352) 873-4458

Fax

(352) 873-8116

NPI assigned

Nov 1, 2006

Last updated

Sep 1, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth Baruch Lee, DONPI 1023195112

Title

Owner President

Phone

(352) 873-4458

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

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.

• Kenneth Baruch Lee, DO

  • Family Medicine Physician
  • Ocala, FL
  • NPI 1023195112
  Medicare reassignment Care Compare group NPD Authorized official
• Clara L De Jesus Kalil, M.D.

  • General Practice Physician
  • Ocala, FL
  • NPI 1528218971
  Medicare reassignment Care Compare group NPD
• Kayli Taylor, ARNP

  • Family Nurse Practitioner
  • Tavares, FL
  • NPI 1801515416
  Medicare reassignment Care Compare group NPD
• Roberto Rodriguez-Perez, MD

  • General Practice Physician
  • Okeechobee, FL
  • NPI 1184606618

  Internal Medicine

  Medicare reassignment NPD
• Nora Jo M Greenia, ARNP

  • Adult Health Nurse Practitioner
  • Tavares, FL
  • NPI 1326288366
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693526400000",
    "number": "1275610362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 770719",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344770719",
            "telephone_number": "352-873-4458",
            "fax_number": "352-873-8116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7860 SW 103RD STREET RD",
            "address_2": "BLDG 100 SUITE 101",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344768623",
            "telephone_number": "352-873-4458",
            "fax_number": "352-873-8116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE MEDICAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "BARUCH",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "352-873-4458",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CG9421",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lora Coulson, PHARM. D.
• Counseling & Empowerment Services by Karen, Inc
• Counseling & Rehabilitation Associates Inc
• Counseling & Resource Center
• Countryside Housecalls Inc (Countryside House Calls)
• Courtesy Transport Services, LLC
• Robert Gordon Coutu, MS, ATC
• Covenant Hospitalists PLLC
• Covenant Ventures Inc. (Classic Pharmacy)
• Melissa Cowan

• Internal Medicine Physician in Ocala, FL
• Providers in Ocala, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; 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.