Organization Active NPI

Starke Family Medical Center Inc

  • General Practice Physician
  • Keystone Heights, FL
National Provider Identifier
1407518541
Registry record updated Oct 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
STARKE FAMILY MEDICAL CENTER INC
Practice address
175 N Lawrence Blvd
Keystone Heights, FL 32656-9351
Phone
(352) 473-3199
NPI assigned
Oct 6, 2021
Organization subpart
Yes
Parent organization
STARKE FAMILY MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 6, 2021

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

Authorized official

Name
Michele Denise Bazile
Title
Director
Phone
(904) 964-5455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

175 N Lawrence Blvd
Keystone Heights, FL 32656-9351

Mailing address

345 W Madison St
Starke, FL 32091-3923
Phone (904) 964-5455

Other names 1

  • Village Doctors Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2026125Village Doctors Family Medical Center of175 N Lawrence Blvd, Keystone Heights, FL 32656Certificate of waiverJun 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Starke Family Med Center4 organizations share this tax ID, including this one
Part of
Starke Family Med Center

Other organizations with this tax ID 3

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

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16275/brand/1/csg/1/fhir/r4

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633478400000",
    "number": "1407518541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 W MADISON ST",
            "city": "STARKE",
            "state": "FL",
            "postal_code": "320913923",
            "telephone_number": "904-964-5455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 N LAWRENCE BLVD",
            "city": "KEYSTONE HEIGHTS",
            "state": "FL",
            "postal_code": "326569351",
            "telephone_number": "352-473-3199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STARKE FAMILY MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STARKE FAMILY MEDICAL CENTER, INC.",
        "enumeration_date": "2021-10-06",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A",
        "authorized_official_last_name": "BAZILE",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "904-964-5455"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Village Doctors",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Keystone Heights, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.