NPIMap

Organization Active NPI

Primary Care Medical Services of Poinciana Inc

Doing business as Osceola Community Health Services at Fortune Rd

  • Federally Qualified Health Center (FQHC)
  • Kissimmee, FL
National Provider Identifier
1376093609
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY CARE MEDICAL SERVICES OF POINCIANA INC
Doing business as
Osceola Community Health Services at Fortune Rd
Practice address
1503 Bill Beck Blvd
Kissimmee, FL 34744-9516
Phone
(407) 943-8600
NPI assigned
Oct 11, 2016
Last updated
Aug 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Authorized official

Name
Belinda Johnson-Cornett
Title
Ceo
Phone
(407) 943-8670

Specialties & licenses 1

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

Addresses

Primary practice location

1503 Bill Beck Blvd
Kissimmee, FL 34744-9516

Mailing address

1503 Bill Beck Blvd
Kissimmee, FL 34744-9516
Phone (407) 943-8600

Other practice location 1

1877 Fortune Rd
Kissimmee, FL 34744-4428
Phone (407) 943-8600

Other practice location 2

1875 Fortune Rd Bldg 1
Kissimmee, FL 34744-4428
Phone (407) 943-8600

Other names 1

  • Osceola Community Health Services at Fortune Rd Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181005000584 FL Part B Supplier - Clinic/Group Practice 4486923059 Receives reassigned benefits from 15 practitioners
Practice locations: Kissimmee, FL; Saint Cloud, FL

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory

Locations

1875 Fortune Rd
Kissimmee, FL 34744
Phone (407) 343-2000

1875 Fortune Rd
Bldg 1
Kissimmee, FL 34744

Networks

  • HealthSun Health Plans Network

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Osceola Community Health Services in BVLKissimmee, FL, CCN 681125 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2017
Osceola Community Health Services at Cameron PreserveKissimmee, FL, CCN 101018 Federally qualified health center Operational/Managerial Control Sep 30, 2019

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1476144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1376093609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 BILL BECK BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347449516",
            "telephone_number": "407-943-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 BILL BECK BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347449516",
            "telephone_number": "407-943-8600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1877 Fortune Rd",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347444428",
            "country_code": "US",
            "telephone_number": "407-943-8600",
            "fax_number": "321-250-3862",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1875 Fortune Rd Bldg 1",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347444428",
            "country_code": "US",
            "telephone_number": "407-943-8600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIMARY CARE MEDICAL SERVICES OF POINCIANA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-11",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-CORNETT",
        "authorized_official_first_name": "BELINDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "407-943-8670"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Osceola Community Health Services at Fortune Rd",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Osceola Community Health Services at Fortune Rd",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.