A Suncoast Life, Inc.

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Legal business name

A SUNCOAST LIFE, INC.

Doing business as

A Suncoast Life, Inc.

Practice address

1100 E Bay Dr # G-78
Largo, FL 33770-2541

Phone

(239) 888-3111

NPI assigned

Jan 25, 2021

Last updated

Jan 25, 2021By 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

Johnathan Eric FourthmanNPI 1689090979

Title

President/Owner

Phone

(239) 888-3111

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• A Suncoast Life, Inc. Doing business as

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.

• Johnathan Eric Fourthman

  • Social Worker
  • Tampa, FL
  • NPI 1689090979
  NPD Authorized official

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

{
    "created_epoch": "1611532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611532800000",
    "number": "1306436159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 E BAY DR # G-78",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337702541",
            "telephone_number": "239-888-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E BAY DR # G-78",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337702541",
            "telephone_number": "239-888-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A SUNCOAST LIFE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-25",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A",
        "authorized_official_last_name": "FOURTHMAN",
        "authorized_official_first_name": "JOHNATHAN",
        "authorized_official_middle_name": "ERIC",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "239-888-3111"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689090979",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A Suncoast Life, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Case Manager/Care Coordinator in Largo, FL
• Providers in Largo, FL by specialty
• Case Manager/Care Coordinator in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; 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.