Garcia Medical Clinic LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

ME59559 Issued in FL

Legal business name

GARCIA MEDICAL CLINIC LLC

Practice address

411 E Nelson Ave
Defuniak Springs, FL 32433-7444

Phone

(850) 892-4791

Fax

(850) 892-3868

NPI assigned

Mar 21, 2007

Last updated

Jun 19, 2017By 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

Mr. Ruben Ruiz Garcia Jr., M.D.NPI 1639265846

Title

Physician/Owner

Phone

(850) 892-4791

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407971922. Details of each certification follow.

• CCN 108975 Rural health clinic · Active · Details

Rural health clinic certification: CCN 108975

Legal name

GARCIA MEDICAL CLINIC LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Apr 20, 2004

Last certification

Feb 3, 2020

Ownership / control type

1B

Most recent change of ownership

Jan 1, 2007 (1 total)

Organization structure

LLCProprietary

Incorporated

Jan 1, 2007 in FL

Enrollment address

411 E Nelson Ave
Defuniak Springs, FL 32433-7444

Tax ID family

Garcia Medical Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Garcia Medical Clinic

  • Clinic/Center
  • Defuniak Springs, FL
  • NPI 1841339694
  NPD tax ID

Locations

All disclosed owners & managing parties 1

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Ruben R Garcia, M.D.

  • Family Medicine Physician
  • Defuniak Springs, FL
  • NPI 1639265846

  5% Or Greater Direct Ownership Interest, Corporate Director, W-2 Managing Employee

  CMS ownership

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.

• Ruben R Garcia, M.D.

  • Family Medicine Physician
  • Defuniak Springs, FL
  • NPI 1639265846

  General Practice

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497830400000",
    "number": "1407971922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 E NELSON AVE",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324337444",
            "telephone_number": "850-892-4791",
            "fax_number": "850-892-3868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 E NELSON AVE",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324337444",
            "telephone_number": "850-892-4791",
            "fax_number": "850-892-3868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARCIA MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2017-06-19",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "RUBEN",
        "authorized_official_middle_name": "RUIZ",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "850-892-4791",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME59559",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "ME59559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Fleming
• Florida Department of Health (Walton Community Health Center)
• Florida Department of Health
• Molly B Fulmer
• Garcia Medical Clinic
• Ruben R Garcia, M.D.
• Madelyn Garrett
• Jessica Laurette Gentry, M.S., CCC-SLP
• Albert Zachary Ghazal, DMD
• Jacqueline M Gibson, LMHC

• Clinic/Center in Defuniak Springs, FL
• Providers in Defuniak Springs, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.