NPIMap

Organization Active NPI

The Medical Centre of Lehigh Acres Inc

  • Primary Care Clinic/Center
  • Lehigh Acres, FL
National Provider Identifier
1508179490
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
1508179490 Issued in FL
Legal business name
THE MEDICAL CENTRE OF LEHIGH ACRES INC
Practice address
1303 Homestead Rd N Ste 102
Lehigh Acres, FL 33936-6049
Phone
(239) 303-2700
Fax
(239) 303-2756
NPI assigned
Jul 20, 2010
Last updated
Nov 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Authorized official

Name
Ralph S Ryback, M.DNPI 1831146141
Title
President
Phone
(239) 303-2700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X ME 92563 FL
Primary Care Clinic/Center 261QP2300X 1508179490 FL Primary

Addresses

Primary practice location

1303 Homestead Rd N Ste 102
Lehigh Acres, FL 33936-6049

Mailing address

1303 Homestead Rd N Ste 102
Lehigh Acres, FL 33936-6049
Phone (239) 303-2700

Other identifiers 2

IdentifierTypeStateIssuer
HCC8330OtherFLAHCA EXEMPTION
1508179490OtherFLNPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131009000034 FL Part B Supplier - Clinic/Group Practice 2860626777 Receives reassigned benefits from 11 practitioners
Practice locations: Lehigh Acres, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2072466Medical Center of Lehigh Acres Inc, the1303 Homestead Rd N Ste 102, Lehigh Acres, FL 33936Certificate of waiverJan 30, 2028

National Provider Directory

National Provider Directory

Locations

1303 Homestead Rd N
Ste 102
Lehigh Acres, FL 33936
Phone (239) 303-2700

Practitioners & affiliated clinicians

Practitioners 11

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": "1279584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606176000000",
    "number": "1508179490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 HOMESTEAD RD N STE 102",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339366049",
            "telephone_number": "239-303-2700",
            "fax_number": "239-303-2756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 HOMESTEAD RD N STE 102",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339366049",
            "telephone_number": "239-303-2700",
            "fax_number": "239-303-2756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MEDICAL CENTRE OF LEHIGH ACRES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-20",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A",
        "authorized_official_last_name": "RYBACK",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-303-2700",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "ME 92563",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "1508179490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA EXEMPTION",
            "identifier": "HCC8330",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1508179490",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lehigh Acres, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.