Organization Active NPI

Family Health Enterprises Inc

Doing business as Lady Lake Family Medicine

  • Family Medicine Physician
  • Lady Lake, FL
National Provider Identifier
1538192075
Registry record updated Feb 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY HEALTH ENTERPRISES INC
Doing business as
Lady Lake Family Medicine
Practice address
607 Highway 466
Lady Lake, FL 32159-3792
Phone
(352) 259-7994
Fax
(352) 259-7992
NPI assigned
Jul 8, 2006
Last updated
Feb 6, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2013

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

Authorized official

Name
Dr. John D Burress, DONPI 1649295973
Title
President
Phone
(352) 259-7994

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

607 Highway 466
Lady Lake, FL 32159-3792

Mailing address

PO Box 1777
Lady Lake, FL 32158-1777
Phone (352) 259-7994

Other identifiers 1

IdentifierTypeStateIssuer
DC9694OtherFLRAILROAD MEDICARE

Other names 1

  • Lady Lake Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205001125 FL Part B Supplier - Clinic/Group Practice 9830082536 Receives reassigned benefits from 9 practitioners
Practice locations: Lady Lake, 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
10D0997539Lady Lake Family Medicine607 Highway 466, Lady Lake, FL 32159Certificate of waiverSep 27, 2027

National Provider Directory

National Provider Directory

Locations

607 Highway 466
Lady Lake, FL 32159
Phone (352) 259-7994

607 Highway 466
Ste B
Lady Lake, FL 32159
Phone (352) 259-7994

Practitioners & affiliated clinicians

Practitioners 10

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": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360108800000",
    "number": "1538192075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1777",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321581777",
            "telephone_number": "352-259-7994",
            "fax_number": "352-259-7992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 HIGHWAY 466",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321593792",
            "telephone_number": "352-259-7994",
            "fax_number": "352-259-7992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH ENTERPRISES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2013-02-06",
        "status": "A",
        "authorized_official_last_name": "BURRESS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-259-7994",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC9694",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lady Lake Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lady Lake, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2013; 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.