Mary Lee Depugh Nursing Home Association, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1324096 Issued in FL

Legal business name

MARY LEE DEPUGH NURSING HOME ASSOCIATION, INC

Practice address

550 W Morse Blvd
Winter Park, FL 32789-4206

Phone

(407) 644-6634

Fax

(407) 645-2520

NPI assigned

Mar 21, 2007

Organization subpart

No

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

Authorized official

Name

Karen Northover, NHA

Title

Administrator

Phone

(407) 644-6634

Specialties & licenses 1

Addresses

Other identifiers 1

Networks

• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1497870927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 W MORSE BLVD",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894206",
            "telephone_number": "407-644-6634",
            "fax_number": "407-645-2520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 W MORSE BLVD",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327894206",
            "telephone_number": "407-644-6634",
            "fax_number": "407-645-2520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY LEE DEPUGH NURSING HOME ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "NORTHOVER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "407-644-6634",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1324096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020158800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claudine Annette Martinez, M.A,
• Gabriel Joshua Martinez, MSW
• Jennifer Martinez, OTR/L
• Pablo Martinez, DMD
• Mary Beth Griffis
• Casandra Mas Pagan
• Emma Jane Mason, L.M.T.
• Eric S Mason, PT
• Katherine Mason
• Micah Koinyan Massaquoi Jr., LMHC

• Skilled Nursing Facility in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; 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.