NPIMap

Organization Active NPI

Family Practice-St Cloud, Inc.

Doing business as ProHealth Family Physicians

  • Family Medicine Physician
  • Saint Cloud, FL
National Provider Identifier
1336189190
Registry record updated Feb 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME0036943 Issued in FL
Legal business name
FAMILY PRACTICE-ST CLOUD, INC.
Doing business as
ProHealth Family Physicians
Practice address
3100 17TH St
Saint Cloud, FL 34769-6021
Phone
(407) 892-0009
Fax
(407) 892-3285
NPI assigned
Jun 8, 2006
Last updated
Feb 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2023

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

Authorized official

Name
Dr. John Frederick Wilker, MDNPI 1770540361
Title
President
Phone
(407) 892-0009

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 ME0036943 FL Primary

Addresses

Primary practice location

3100 17TH St
Saint Cloud, FL 34769-6021

Mailing address

3100 17TH St
Saint Cloud, FL 34769-6021
Phone (407) 892-0009

Other identifiers 1

IdentifierTypeStateIssuer
34984OtherFLBLUE CROSS BLUE SHEILD

Other names 1

  • ProHealth Family Physicians Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040106000234 FL Part B Supplier - Clinic/Group Practice 3274432521 Receives reassigned benefits from 8 practitioners
Practice locations: Saint Cloud, 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
10D0299033Family Practice - St Cloud Inc Dba Prohealth3100 17TH St Ste a, Saint Cloud, FL 34769Certificate of waiverNov 7, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3100 17th St
Saint Cloud, FL 34769
Phone (407) 891-3500

3100 17th St
Ste A
Saint Cloud, FL 34769
Phone (407) 891-3500

3100 17th St
Ste B
Saint Cloud, FL 34769
Phone (407) 892-0009

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675641600000",
    "number": "1336189190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 17TH ST",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347696021",
            "telephone_number": "407-892-0009",
            "fax_number": "407-892-3285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 17TH ST",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347696021",
            "telephone_number": "407-892-0009",
            "fax_number": "407-892-3285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE-ST CLOUD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A",
        "authorized_official_last_name": "WILKER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "FREDERICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-892-0009",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0036943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "34984",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProHealth Family Physicians",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ProHealth Family Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Cloud, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.