NPIMap

Organization Active NPI

Phoenix Primary Care LLC

  • Primary Care Clinic/Center
  • Palm Coast, FL
National Provider Identifier
1508489790
Registry record updated May 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PHOENIX PRIMARY CARE LLC
Practice address
26B Office Park Dr
Palm Coast, FL 32137-3808
Phone
(386) 597-2861
Fax
(844) 272-3971
NPI assigned
May 21, 2020
Organization subpart
Yes
Parent organization
ABUNDANT LIFE MINISTRIES-HOPE HOUSE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 21, 2020

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

Authorized official

Name
Ms. Sandra Shank
Title
Ceo
Phone
(386) 597-2861

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

26B Office Park Dr
Palm Coast, FL 32137-3808

Mailing address

PO Box 354925
Palm Coast, FL 32135-4925
Phone (386) 597-2861

Other names 1

  • Abundant Life Ministries-Hope House, Inc. Other name

National Provider Directory

National Provider Directory
Part of
Abundant Life Ministries-Hope House Inc

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21865/brand/1/csg/21/fhir/r4

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1590019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590019200000",
    "number": "1508489790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 354925",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321354925",
            "telephone_number": "386-597-2861",
            "fax_number": "844-272-3971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26B OFFICE PARK DR",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321373808",
            "telephone_number": "386-597-2861",
            "fax_number": "844-272-3971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX PRIMARY CARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ABUNDANT LIFE MINISTRIES-HOPE HOUSE, INC.",
        "enumeration_date": "2020-05-21",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A",
        "authorized_official_last_name": "SHANK",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "386-597-2861",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Abundant Life Ministries-Hope House, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Palm Coast, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.