Lake Wales Clinic Corp

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LAKE WALES CLINIC CORP

Practice address

410 S 11TH St
Lake Wales, FL 33853-4203

Phone

(863) 676-1433

NPI assigned

Jul 18, 2005

Organization subpart

Yes

Parent organization

LAKE WALES CLINIC CORPAs reported in NPPES

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

Authorized official

Name

James P Wright

Title

VP Physician Business Services

Phone

(615) 778-1502

Specialties & licenses 8

Addresses

Other identifiers 2

Electronic endpoints 1

Part of

Lake Wales Clinic Corp

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/27269/brand/1/csg/1/fhir/r4

Practitioners 9

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

• Robert E. Lee Browning IV, M.D.

  • Surgical Critical Care Physician
  • Lake Wales, FL
  • NPI 1093972804

  Surgery

  NPD (past)
• Mel Francis Garrovillo, M.D.

  • Surgery Physician
  • Davenport, FL
  • NPI 1578590014
  NPD (past)
• Oji Joseph, M.D.

  • Cardiovascular Disease Physician
  • Lake Wales, FL
  • NPI 1720080096
  NPD (past)
• Melissa Ann Lovemore Wright, APRN

  • Family Nurse Practitioner
  • Lake Wales, FL
  • NPI 1770369332
  NPD (past)
• Christopher G Mondello, D.O.

  • Family Medicine Physician
  • Dundee, FL
  • NPI 1598761124
  NPD (past)
• Ponnavolu D. Reddy, MD

  • Orthopaedic Surgery Physician
  • Sebring, FL
  • NPI 1154327781
  NPD (past)
• Priya Sharma, MD

  • Surgery Physician
  • Sebring, FL
  • NPI 1629369590
  NPD (past)
• Scott Owen Johnson, MD

  • Surgery Physician
  • Lancaster, OH
  • NPI 1528058971
  NPD (past)
• Mark K Lavigne, MD

  • Otolaryngology Physician
  • Laurinburg, NC
  • NPI 1982736427
  NPD (past)

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

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563753600000",
    "number": "1457350027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-778-8196",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 S 11TH ST",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534203",
            "telephone_number": "863-676-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE WALES CLINIC CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE WALES CLINIC CORP",
        "enumeration_date": "2005-07-18",
        "last_updated": "2019-07-22",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "VP PHYSICIAN BUSINESS SERVICES",
        "authorized_official_telephone_number": "615-778-1502"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "26904200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "74943",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ppsi_enrollment@chs.net",
            "affiliation": "N",
            "address_1": "410 S 11th St",
            "city": "Lake Wales",
            "state": "FL",
            "country_code": "US",
            "postal_code": "338534203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• L & E Helping Hands LLC
• Salim Lahlou, M.D.
• Lake Wale Pediatric Internal Medicine P.a.
• Lake Wales Charter Schools Inc
• Lake Wales Chiropractic Center Inc
• Lake Wales Dental Associates
• Lake Wales Emergency Physicians, LLC
• Lake Wales Foot and Ankle Care, Inc
• Lake Wales Healthcare LLC (Grace Healthcare of Lake Wales)
• Lake Wales Hospital Corporation (Lake Wales Medical Center)

• Family Medicine Physician in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.