Vida Medical Clinic LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

VIDA MEDICAL CLINIC LLC

Practice address

1960 E Osceola Pkwy
Kissimmee, FL 34743-8626

Phone

(407) 978-6400

Fax

(407) 530-4326

NPI assigned

Jun 24, 2020

Organization subpart

No

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

Authorized official

Name

Karem M Feeley

Title

Administrator

Phone

(407) 978-6400

Specialties & licenses 1

Addresses

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 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carlos Javier Lugo, MD

  • General Practice Physician
  • Kissimmee, FL
  • NPI 1013951797
  Medicare reassignment NPD
• Jose Abel Fernandez Marimon, NP

  • Family Nurse Practitioner
  • Orlando, FL
  • NPI 1649108846
  NPD (past)
• Jackeline Nunez, M.D.

  • General Practice Physician
  • St Petersburg, FL
  • NPI 1912032558
  NPD (past)

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

{
    "created_epoch": "1592956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682985600000",
    "number": "1356967475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7550 FUTURES DR STE 104",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328199096",
            "telephone_number": "407-978-6400",
            "fax_number": "407-530-4502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 E OSCEOLA PKWY",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347438626",
            "telephone_number": "407-978-6400",
            "fax_number": "407-530-4326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7550 Futures Dr Ste 104",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328199096",
            "country_code": "US",
            "telephone_number": "407-978-6400",
            "fax_number": "407-530-4502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VIDA MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-24",
        "last_updated": "2023-05-02",
        "certification_date": "2023-03-21",
        "status": "A",
        "authorized_official_last_name": "FEELEY",
        "authorized_official_first_name": "KAREM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "407-978-6400"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yoleinis Vicente Chaviano
• Karisma Vicioso
• Victor Guzman
• Victor Politano Jr DO PA
• Victoria Floral Gardens Corp
• Vida Plus Medical LLC
• Carmen Julia Vidal Marquez
• Andrea Alejandra Vidal
• Idalberto Vidal
• Vietrulife Medical Spa Corp

• General Practice Physician in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 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.