NPIMap

Organization Active NPI

Innovative Primary Care PLC

Doing business as Lake Palliative Care Providers

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Eustis, FL
National Provider Identifier
1346524956
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
Legal business name
INNOVATIVE PRIMARY CARE PLC
Doing business as
Lake Palliative Care Providers
Practice address
901 N Grove St
Eustis, FL 32726-2805
Phone
(352) 508-7040
NPI assigned
Sep 30, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

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

Authorized official

Name
Dr. Ajit Vallabhdas Hansalia, M.D.
Title
Member
Phone
(352) 638-6493

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RH0002X Primary

Addresses

Primary practice location

901 N Grove St
Eustis, FL 32726-2805

Mailing address

901 N Grove St
Eustis, FL 32726-2805
Phone (352) 508-7040

Other identifiers 1

IdentifierTypeStateIssuer
H524018710510OtherFLDRIVER LICENSE

Other names 1

  • Lake Palliative Care Providers Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL rxnt Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Locations

380 S State Road 434
Ste 1004341
Altamonte Springs, FL 32714

901 N Grove St
Eustis, FL 32726
Phone (352) 508-7040

3775 Lake Center Dr
Mount Dora, FL 32757
Phone (352) 508-7040

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FAEBAA
  • FHIR API: https://api.platform.athenahealth.com/18839/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 6

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": "1317340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677024000000",
    "number": "1346524956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 N GROVE ST",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327262805",
            "telephone_number": "352-508-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 N GROVE ST",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327262805",
            "telephone_number": "352-508-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PRIMARY CARE PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-30",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A",
        "authorized_official_last_name": "HANSALIA",
        "authorized_official_first_name": "AJIT",
        "authorized_official_middle_name": "VALLABHDAS",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "352-638-6493",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER LICENSE",
            "identifier": "H524018710510",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "rxnt",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "901 N Grove St",
            "city": "Eustis",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327262805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lake Palliative Care Providers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eustis, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; 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.