Regen Primary Medical LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

REGEN PRIMARY MEDICAL LLC

Practice address

8390 Champions Gate Blvd Ste 108
Champions Gate, FL 33896-8311

Phone

(714) 551-9576

NPI assigned

Jul 24, 2020

Organization subpart

No

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

Authorized official

Name

Bryn Henderson

Title

Owner

Phone

(714) 551-9576

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595548800000",
    "number": "1508475682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8390 CHAMPIONS GATE BLVD STE 108",
            "city": "CHAMPIONS GATE",
            "state": "FL",
            "postal_code": "338968311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8390 CHAMPIONS GATE BLVD STE 108",
            "city": "CHAMPIONS GATE",
            "state": "FL",
            "postal_code": "338968311",
            "telephone_number": "714-551-9576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGEN PRIMARY MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-24",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "BRYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-551-9576"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Champions Gate, FL
• Providers in Champions Gate, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; 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.