Citrus Gastroenterology PA

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

80110022812 Issued in FL

Legal business name

CITRUS GASTROENTEROLOGY PA

Practice address

3653 E Forest Dr
Inverness, FL 34453-0787

Phone

(352) 344-8080

Fax

(352) 344-0631

NPI assigned

Jul 7, 2005

Last updated

Jun 21, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Johannes Martensson, M.D.NPI 1417954298

Title

President

Phone

(352) 344-8080

Specialties & licenses 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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.

• Johannes Karl Martensson, M.D.

  • Gastroenterology Physician
  • Inverness, FL
  • NPI 1417954298
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308614400000",
    "number": "1407853195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3653 E FOREST DR",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344530787",
            "telephone_number": "352-344-8080",
            "fax_number": "352-344-0631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3653 E FOREST DR",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344530787",
            "telephone_number": "352-344-8080",
            "fax_number": "352-344-0631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITRUS GASTROENTEROLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2011-06-21",
        "status": "A",
        "authorized_official_last_name": "MARTENSSON",
        "authorized_official_first_name": "JOHANNES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-344-8080",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "80110022812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENNESSEE",
            "identifier": "4002702",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2900981",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "21861",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "160659200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "84959",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHEASE",
            "identifier": "213279",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "2400710",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS OF PENNSYLVANIA",
            "identifier": "173547",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "263450300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "CN7015",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Citrus Dental Association, P.a.
• Citrus Dental of Inverness, P.a.
• Citrus Dental Sleep Medicine, PA (Dental Sleep Solutions, LLC)
• Citrus Emergency Services, PA
• Citrus Gastroenterology MGT PLC
• Citrus Health Associates, PLLC
• Citrus Infusion and Injection Center, Inc.
• Citrus Memorial Health Foundation Inc (Citrus Memorial Health System)
• Citrus Memorial Health Foundation Inc (Citrus Primary Care)
• Citrus Memorial Health Foundation Inc

• Gastroenterology Physician in Inverness, FL
• Providers in Inverness, FL by specialty
• Gastroenterology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.