NPIMap

Organization Active NPI

John Knox Village of Central Florida Inc

  • Long Term Care Pharmacy
  • Orange City, FL
National Provider Identifier
1386033736
Registry record updated Feb 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PH28804 Issued in FL
Legal business name
JOHN KNOX VILLAGE OF CENTRAL FLORIDA INC
Practice address
701 Monastery Rd Ste B
Orange City, FL 32763-6222
Phone
(386) 456-1500
NPI assigned
Jan 22, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2015

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

Authorized official

Name
Vibha Choudhary
Title
Pharmacy Director
Phone
(386) 456-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X PH28804 FL Primary

Addresses

Primary practice location

701 Monastery Rd Ste B
Orange City, FL 32763-6222

Mailing address

701 Monastery Rd
Suite B
Orange City, FL 32763-6222
Phone (386) 456-1500

Other identifiers 1

IdentifierTypeStateIssuer
2149648OtherPK

Other names 1

  • Oak Park LTC Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150706000804 FL Part B Supplier - Pharmacy 4284785205 1 other NPI on this enrollment
Practice locations: Orange City, FL

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Oak Park Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

701 Monastery Rd
Ste B
Orange City, FL 32763
Phone (386) 456-1500

Networks

  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
John Knox Village of Central Florida Inc.Orange City, FL, CCN 107530 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 May 16, 1996
Jan 1, 2015

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1421884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424649600000",
    "number": "1386033736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 MONASTERY RD",
            "address_2": "SUITE B",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327636222",
            "telephone_number": "386-456-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 MONASTERY RD STE B",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327636222",
            "telephone_number": "386-456-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN KNOX VILLAGE OF CENTRAL FLORIDA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-22",
        "last_updated": "2015-02-23",
        "status": "A",
        "authorized_official_last_name": "CHOUDHARY",
        "authorized_official_first_name": "VIBHA",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "386-456-1500"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "FL",
            "license": "PH28804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2149648",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oak Park LTC Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange City, FL

Sources for this page

Verify at the official NPI Registry.