South Lake Gastroenterology Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME74082 Issued in FL

Legal business name

SOUTH LAKE GASTROENTEROLOGY INC

Practice address

2040 Oakley Seaver Dr
Clermont, FL 34711-1962

Phone

(352) 242-1665

Fax

(352) 243-1649

NPI assigned

Sep 11, 2007

Last updated

Jul 18, 2014By 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. Ramesh Rampersad

Title

Administrator

Phone

(352) 242-1665

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Heart of Florida Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Davenport, FL
  • NPI 1629420922

  Member Of

  NPD member

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JJABCA

Practitioners 9

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.

• Rajab K Abukhadrah, M.D.

  • Specialist
  • Clermont, FL
  • NPI 1023083896
  Medicare reassignment Care Compare group NPD
• Tammy Covington, NP-C

  • Family Nurse Practitioner
  • Clermont, FL
  • NPI 1831599893
  Medicare reassignment Care Compare group NPD
• Khalid Maqsood, M.D.

  • Gastroenterology Physician
  • Clermont, FL
  • NPI 1629047378
  Medicare reassignment Care Compare group NPD
• Maria Rosario Pagan, APNC

  • Nurse Practitioner
  • Clermont, FL
  • NPI 1134272628
  Medicare reassignment Care Compare group NPD
• Fadi Elia Rahhal, MD

  • Gastroenterology Physician
  • Clermont, FL
  • NPI 1306062724
  Medicare reassignment Care Compare group NPD
• Syed K Lateef, M.D.

  • Gastroenterology Physician
  • Clermont, FL
  • NPI 1194769836
  Medicare reassignment NPD
• Chantal P Baptiste, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Clermont, FL
  • NPI 1851867766

  Multi-Specialty

  NPD (past)
• Hung-Wei Lee, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Bradenton, FL
  • NPI 1871628529
  NPD (past)
• Amber Lynn Reffitt, APRN

  • Gerontology Nurse Practitioner
  • Clermont, FL
  • NPI 1023601762
  NPD (past)

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405641600000",
    "number": "1467647685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 120930",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347120930",
            "telephone_number": "352-242-1665",
            "fax_number": "352-243-1649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 OAKLEY SEAVER DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111962",
            "telephone_number": "352-242-1665",
            "fax_number": "352-243-1649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LAKE GASTROENTEROLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2014-07-18",
        "status": "A",
        "authorized_official_last_name": "RAMPERSAD",
        "authorized_official_first_name": "RAMESH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "352-242-1665",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME74082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL",
            "identifier": "E0302Z",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL BCBS",
            "identifier": "43437",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256031300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5858631",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Lake Anesthesia Services, P.a.
• South Lake Arthritis and Rheumatology, LLC (South Lake Arthritis and Rheumatology)
• South Lake Cardiology, LLC
• South Lake Chiropractic PA
• South Lake Family Counseling Services
• South Lake Hospital Inc
• South Lake Hospital Inc
• South Lake Hospital, Inc. (Orlando Health South Lake Hospital)
• South Lake Hospital, Inc. (South Lake Home Health)
• South Lake Hospital, Inc. (Orlando Health Cancer Institute)

• Specialist in Clermont, FL
• Providers in Clermont, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2014; 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.