NPIMap

Organization Active NPI

Palm Medical Center Lakeland LLC

  • Clinic/Center
  • Lakeland, FL
National Provider Identifier
1437650579
Registry record updated Sep 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PALM MEDICAL CENTER LAKELAND LLC
Practice address
135 E 1St St
Lakeland, FL 33805-4609
Phone
(863) 686-2728
NPI assigned
Feb 23, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2021

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

Authorized official

Name
Santiago Moises Martin
Title
Coo
Phone
(305) 913-9441

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

135 E 1St St
Lakeland, FL 33805-4609

Mailing address

2600 S Douglas Rd Ste 308
Coral Gables, FL 33134-6134

Other practice location 1

5985 S Florida Ave
Lakeland, FL 33813-2533
Phone (863) 644-8459

Other practice location 2

127 Ridge Center Dr
Davenport, FL 33837-6401
Phone (863) 421-7400

Other practice location 3

5035 E Busch Blvd Ste 1A&1B
Tampa, FL 33617-5310
Phone (813) 988-4400

Other practice location 4

1509 W Reynolds St
Plant City, FL 33563-4733
Phone (813) 704-6905

Other practice location 5

175 US Highway 17 N
Bartow, FL 33830-4140
Phone (863) 533-8215

Other practice location 6

950 1st St S
Winter Haven, FL 33880-3665
Phone (863) 295-5604

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160818001144 FL Part B Supplier - Clinic/Group Practice 8224323050 Receives reassigned benefits from 72 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Land O Lakes, FL; Plantation, FL; Port Richey, FL; Sebring, FL; Plant City, FL; Spring Hill, FL; Tamarac, FL; Tampa, FL…
O20190507000857 FL Part B Supplier - Clinic/Group Practice 9830431188 Receives reassigned benefits from 14 practitioners
Practice locations: Tampa, FL; Zephyrhills, FL; Winter Haven, FL; Plant City, FL; Land O Lakes, FL; Lakeland, FL; Davenport, FL; Bartow, FL

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Palm Medical Centers23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2416 Land O Lakes Blvd
Ste A
Land O Lakes, FL 34639
Phone (813) 235-6200

11017 N Dale Mabry Hwy
Tampa, FL 33618
Phone (813) 962-4888

5035 E Busch Blvd
Ste 1A
Tampa, FL 33617

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1519344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632268800000",
    "number": "1437650579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 S DOUGLAS RD STE 308",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331346134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 E 1ST ST",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338054609",
            "telephone_number": "863-686-2728"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5985 S Florida Ave",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338132533",
            "country_code": "US",
            "telephone_number": "863-644-8459",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "127 Ridge Center Dr",
            "address_purpose": "LOCATION",
            "city": "Davenport",
            "state": "FL",
            "postal_code": "338376401",
            "country_code": "US",
            "telephone_number": "863-421-7400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5035 E Busch Blvd Ste 1A&1B",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336175310",
            "country_code": "US",
            "telephone_number": "813-988-4400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1509 W Reynolds St",
            "address_purpose": "LOCATION",
            "city": "Plant City",
            "state": "FL",
            "postal_code": "335634733",
            "country_code": "US",
            "telephone_number": "813-704-6905",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "175 US Highway 17 N",
            "address_purpose": "LOCATION",
            "city": "Bartow",
            "state": "FL",
            "postal_code": "338304140",
            "country_code": "US",
            "telephone_number": "863-533-8215",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "950 1st St S",
            "address_purpose": "LOCATION",
            "city": "Winter Haven",
            "state": "FL",
            "postal_code": "338803665",
            "country_code": "US",
            "telephone_number": "863-295-5604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PALM MEDICAL CENTER LAKELAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-23",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A",
        "authorized_official_last_name": "MOISES MARTIN",
        "authorized_official_first_name": "SANTIAGO",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "305-913-9441"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; 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.