Active NPI
Gulf Coast Orthotics & Prosthetics Center, LLC
- Prosthetic/Orthotic Supplier
- Venice, FL
National Provider Identifier
1538355250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- License
- POR 181
- Legal business name
- GULF COAST ORTHOTICS & PROSTHETICS CENTER, LLC
- Practice address
- 4120 Woodmere Park Blvd
Suite 7
Venice, FL 34293-5373 - Phone
- (941) 497-3800
- Fax
- (941) 497-7775
- NPI assigned
- Sep 16, 2007
- Last updated
- Jun 20, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Keith Roderiques, CPO
- Title
- Owner
- Phone
- (941) 497-3800
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | POR 181 | FL | Primary |
Addresses
Primary practice location
4120 Woodmere Park Blvd
Suite 7
Venice, FL 34293-5373
Mailing address
4120 Woodmere Park Blvd
Suite 7
Venice, FL 34293-5373
Phone (941) 497-3800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 749649 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930055215 | FL | DME Supplier - Prosthetic Personnel | 5698971356 | Practice locations: Venice, FL |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Durable Medical Equipment & Medical Supplies
- Port Charlotte, FL
- NPI 1588087001
5698971356
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Gulf Coast Orthotics & Prosthetics | Neuromuscular Elect Stimulators (NMES)/Supplies|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Gulf Coast Orthotics Prosthetics Center LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Port Charlotte, FL
- NPI 1588087001
Locations
21300 Gertrude Ave
Port Charlotte, FL 33952
Phone (941) 408-6246
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189900800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1560988800000",
"number": "1538355250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4120 WOODMERE PARK BLVD",
"address_2": "SUITE 7",
"city": "VENICE",
"state": "FL",
"postal_code": "342935373",
"telephone_number": "941-497-3800",
"fax_number": "941-497-7775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4120 WOODMERE PARK BLVD",
"address_2": "SUITE 7",
"city": "VENICE",
"state": "FL",
"postal_code": "342935373",
"telephone_number": "941-497-3800",
"fax_number": "941-497-7775"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GULF COAST ORTHOTICS & PROSTHETICS CENTER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-09-16",
"last_updated": "2019-06-20",
"status": "A",
"authorized_official_last_name": "RODERIQUES",
"authorized_official_first_name": "KEITH",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "941-497-3800",
"authorized_official_credential": "CPO"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "FL",
"license": "POR 181",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "749649",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Venice, FL
- Gulf Coast Hma Physician Management LLC (Venice Family Practice)
- Gulf Coast Hma Physician Management LLC (GCMG-Tuscany, 1st floor)
- Gulf Coast Hma Physician Management LLC (Gulf Coast Medical Group - Cardiothoracic Surgery Associates)
- Gulf Coast Hma Physician Management LLC (Gulf Coast Foot and Ankle)
- Gulf Coast Hma Physician Management LLC (Regional Cardiac & Vascular Associates)
- Gulf Coast Pediatrics of Sarasota, PA-C
- Gulf Coast Scripts LLC
- Gulf Coast Senior Care Inc (Senior Helpers)
- Gulfmed Centers Inc
- James Joseph Gulick, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; 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.