NPIMap

Organization Active NPI

Family Health Centers of Southwest Florida Inc

  • Federally Qualified Health Center (FQHC)
  • Lehigh Acres, FL
National Provider Identifier
1508027848
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA INC
Practice address
3415 Lee Blvd
Lehigh Acres, FL 33971-1576
Phone
(239) 344-2305
Fax
(239) 368-2044
NPI assigned
Jun 19, 2008
Last updated
May 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Authorized official

Name
Frank Mazzeo Jr.NPI 1962597047
Title
President Ceo
Phone
(239) 278-3600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

3415 Lee Blvd
Lehigh Acres, FL 33971-1576

Mailing address

PO Box 919771
Orlando, FL 32891-9771
Phone (239) 278-3600

Other identifiers 2

IdentifierTypeStateIssuer
056887204MedicaidFL
029570105MedicaidFL

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040106000084 FL Part B Supplier - Clinic/Group Practice 3173432085 Receives reassigned benefits from 36 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Port Charlotte, FL; Lehigh Acres, FL; Labelle, FL; Fort Myers, FL; Bonita Springs, FL; Cape Coral, FL
O20081022000048 FL Part A Provider - Federally Qualified Health Center (FQHC) 3173432085 Practice locations: Lehigh Acres, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508027848. Details of each certification follow.

Federally qualified health center certification: CCN 101913

Legal name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 17, 1996
Last certification
Jan 17, 1996
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 13, 1977 in FL
Enrollment address
3415 Lee Blvd
Lehigh Acres, FL 33971-1576

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Debra C Skinner MD29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Grace Alexander-Cortez Individual Corporate DirectorBoard Member Mar 1, 2019
Catherine Palmisano Individual Corporate Director Jan 1, 2020
Leah McCann Individual Corporate DirectorBoard Member May 1, 2013
Patricia Epifanio Individual Corporate DirectorBoard Member Nov 1, 2017
Lolita Winifred Melhado Individual Corporate Director Dec 1, 2020
Jay McGregor Individual Corporate DirectorBoard Member Jun 1, 2015
Beth Hendry Individual Corporate DirectorBoard Member Sep 1, 2018
Jorge M Quinonez Individual Corporate DirectorChief Medical Officer Aug 22, 2008
W-2 Managing EmployeeChief Medical Officer Aug 22, 2008
Estela Aguilar Individual Corporate DirectorBoard Member Mar 1, 2019
Theresa Buchanan Individual Corporate DirectorChief Administrative Officer Aug 22, 2008
W-2 Managing EmployeeChief Administrative Officer Aug 22, 2008
Jose Fernandez Individual Corporate DirectorBoard Member Mar 1, 2016
Tomy Laufer Individual Corporate Director Aug 1, 2016
Frank Mazzeo Individual Corporate DirectorChief Executive Officer Aug 22, 2008
W-2 Managing EmployeeChief Executive Officer Aug 22, 2008

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652832000000",
    "number": "1508027848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 919771",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328919771",
            "telephone_number": "239-278-3600",
            "fax_number": "239-226-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 LEE BLVD",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339711576",
            "telephone_number": "239-344-2305",
            "fax_number": "239-368-2044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-19",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A",
        "authorized_official_last_name": "MAZZEO",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "239-278-3600",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "056887204",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029570105",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lehigh Acres, FL

Sources for this page

Verify at the official NPI Registry.