NPIMap

Organization Active NPI

Family Health Centers of Southwest Florida, Inc.

  • Federally Qualified Health Center (FQHC)
  • Port Charlotte, FL
National Provider Identifier
1295145191
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Practice address
4300 Kings Hwy
Suite 210
Port Charlotte, FL 33980-2917
Phone
(239) 344-2306
Fax
(941) 629-2365
NPI assigned
Apr 30, 2014
Last updated
May 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Authorized official

Name
Frank Mazzeo Jr., DDSNPI 1962597047
Title
President/Ceo
Phone
(239) 278-3600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

4300 Kings Hwy
Suite 210
Port Charlotte, FL 33980-2917

Mailing address

PO Box 919771
Orlando, FL 32891-9771
Phone (239) 278-3600

Other identifiers 3

IdentifierTypeStateIssuer
029570128MedicaidFL
029570127MedicaidFL
99409OtherFLBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040106000084 FL Part B Supplier - Clinic/Group Practice 3173432085 Receives reassigned benefits from 36 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Port Charlotte, FL; Lehigh Acres, FL; Labelle, FL; Fort Myers, FL; Bonita Springs, FL; Cape Coral, FL
O20141021002199 FL Part A Provider - Federally Qualified Health Center (FQHC) 3173432085 Practice locations: Port Charlotte, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295145191. Details of each certification follow.

Federally qualified health center certification: CCN 101180

Legal name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 21, 2014
Last certification
Oct 21, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 13, 1977 in FL
Enrollment address
4300 Kings Hwy 210
Port Charlotte, FL 33980-2922

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Family Health CTRS of SW FL29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Grace Alexander-Cortez Individual Corporate Director Mar 1, 2019
Catherine Palmisano Individual Corporate Director Jan 1, 2020
Leah McCann Individual Corporate Director May 1, 2013
Patricia Epifanio Individual Corporate Director Nov 1, 2017
Lolita Winifred Melhado Individual Corporate Director Dec 1, 2020
Jay McGregor Individual Corporate Director Jun 1, 2015
Beth Hendry Individual Corporate Director Sep 1, 2018
Jorge M Quinonez Individual Corporate OfficerExecutive Vice-President/ Cmo Jul 5, 2005
W-2 Managing EmployeeExecutive Vice-President/ Cmo Jul 5, 2005
Estela Aguilar Individual Corporate Director Mar 1, 2019
Theresa Buchanan Individual Corporate OfficerExecutive Vice-President/ Cao Oct 19, 2009
W-2 Managing EmployeeExecutive Vice-President/ Cao Oct 19, 2009
Jose Fernandez Individual Corporate Director Mar 1, 2016
Tomy Laufer Individual Corporate Director Aug 1, 2016
Frank Mazzeo Individual Corporate OfficerPresident/ Ceo Jun 15, 1999
W-2 Managing EmployeePresident/ Ceo Jun 15, 1999

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1398816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652832000000",
    "number": "1295145191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 919771",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328919771",
            "telephone_number": "239-278-3600",
            "fax_number": "239-226-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 KINGS HWY",
            "address_2": "SUITE 210",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339802917",
            "telephone_number": "239-344-2306",
            "fax_number": "941-629-2365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-30",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A",
        "authorized_official_last_name": "MAZZEO",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "239-278-3600",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029570128",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029570127",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "99409",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.