NPIMap

Organization Active NPI

Central Florida Health Care, Inc.

Doing business as Central Florida Health Care-Lakeland Primary Care

  • Federally Qualified Health Center (FQHC)
  • Lakeland, FL
National Provider Identifier
1386835064
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL FLORIDA HEALTH CARE, INC.
Doing business as
Central Florida Health Care-Lakeland Primary Care
Practice address
1129 N Missouri Ave
Lakeland, FL 33805-4411
Phone
(863) 413-8600
Fax
(863) 413-8651
NPI assigned
Aug 7, 2007
Last updated
Jan 25, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTRAL FLORIDA HEALTH CARE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

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

Authorized official

Name
Ann Claussen
Title
Ceo
Phone
(863) 291-5110

Specialties & licenses 1

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

Addresses

Primary practice location

1129 N Missouri Ave
Lakeland, FL 33805-4411

Mailing address

47 5TH St NW
Winter Haven, FL 33881-4672
Phone (863) 291-5110

Other identifiers 3

IdentifierTypeStateIssuer
691835202OtherFLMEDICAID FQHC
77069IOtherFLMEDICARE FFS
101032OtherFLMEDICARE FQHC

Other names 1

  • Central Florida Health Care-Lakeland Primary Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031218000228 FL Part B Supplier - Clinic/Group Practice 0143127951 Receives reassigned benefits from 157 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lakeland, FL; Winter Haven, FL; Wauchula, FL; Mulberry, FL; Lake Wales, FL; Avon Park, FL; Davenport, FL; Dundee, FL…
O20091009000299 FL Part A Provider - Federally Qualified Health Center (FQHC) 0143127951 Practice locations: Lakeland, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386835064. Details of each certification follow.

Federally qualified health center certification: CCN 101032

Legal name
CENTRAL FLORIDA HEALTH CARE INC
Doing business as
CENTRAL FLORIDA HEALTH CARE-LAKELAND PRIMARY CARE
Organization structure
CorporationNon-profit
Incorporated
Jul 5, 1973 in FL
Enrollment address
1129N Missouri Ave
Lakeland, FL 33805-4411

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Other NPIs on the same Medicare enrollment 20

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

View all 20

National Provider Directory

National Provider Directory
Tax ID family
Lake Avenue Medical Cen87 organizations share this tax ID, including this one
Part of
Lake Avenue Medical Cen

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

305 W Central Ave
Lake Wales, FL 33853
Phone (863) 678-4144

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joyce Evers Individual Corporate OfficerSecretary of Board Nov 18, 2014
Corporate DirectorBoard Member Nov 18, 2014
Nicholas a Emanuel Individual Corporate OfficerVice Chariman of Board Apr 4, 2011
Corporate DirectorBoard Member May 27, 2008
Les Moore Individual Corporate OfficerTreasurer of Board Mar 31, 2015
Corporate DirectorBoard Member Mar 31, 2015
Ann M Claussen Individual Corporate DirectorCeo Jan 1, 2014
W-2 Managing EmployeeCeo Jan 1, 2014
Operational/Managerial ControlCeo Jan 1, 2014
David a Duke Individual Corporate OfficerChariman of the Board Oct 1, 2007
Corporate DirectorBoard Member Jan 19, 1984

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Central Florida Health Care, Inc.-FrostproofFrostproof, FL, CCN 101851 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 1, 1994
Central Florida Health Care IncWinter Haven, FL, CCN 681068 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 30, 2016
Central Florida Health Care IncDundee, FL, CCN 681065 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2020
Central Florida Health Care IncLake Wales, FL, CCN 681066 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 1, 2016
Central Florida Health Care IncLakeland, FL, CCN 681178 Federally qualified health center 5% Or Greater Direct Ownership Interest May 11, 2020
Central Florida Health Care IncDavenport, FL, CCN 691010 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2022
Central Florida Health Care IncBartow, FL, CCN C11021 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 2, 2024

Owned or controlled facilities with NPI records 8

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

Practitioners & affiliated clinicians

Practitioners 86

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 86

NPI Registry JSON

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548374400000",
    "number": "1386835064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 5TH ST NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814672",
            "telephone_number": "863-291-5110",
            "fax_number": "863-291-5124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 N MISSOURI AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338054411",
            "telephone_number": "863-413-8600",
            "fax_number": "863-413-8651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL FLORIDA HEALTH CARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRAL FLORIDA HEALTH CARE INC",
        "enumeration_date": "2007-08-07",
        "last_updated": "2019-01-25",
        "status": "A",
        "authorized_official_last_name": "CLAUSSEN",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "863-291-5110"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID FQHC",
            "identifier": "691835202",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE FFS",
            "identifier": "77069I",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE FQHC",
            "identifier": "101032",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Florida Health Care-Lakeland Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Central Florida Health Care-Lakeland Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.