Central Florida Health Care, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Lakeland, FL
NPI 1568095065 · NPPES record last updated Jun 10, 2020
Key facts
- NPI
- 1568095065
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CENTRAL FLORIDA HEALTH CARE, INC.
- Practice address
- 1417 Lakeland Hills Blvd Ste 101
Lakeland, FL 33805-3200 - Phone
- (863) 229-7970
- NPI assigned
- Feb 13, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- CENTRAL FLORIDA HEALTH CARE, INC.
Authorized official
- Name
- Ann Claussen
- Title
- Ceo
- Phone
- (863) 291-5110
Owners & managing parties with NPI records 20
-
Andrew Hein, DO
-
Karen E McKenzie, DMD
Owned or controlled facilities with NPI records 7
Other NPIs with the same Medicare PAC ID 17
Corporate family (same tax ID) 24
Facilities with the same owner 6
Practitioners 33
-
Leigh A Barberet, ARNP
-
Roseline Blanc, APRN-C
-
Wendy Marie Clark, APRN
-
Esmeralda Gonzales, ARNP
-
Geoffry Michael Hall Jr., ARNP
-
Andrew Hein, DO
-
Donald L Johnson, ARNP
-
Kavita Khorran, PA-C
-
Tara Liske, APRN
-
Wilfredo Lopez-Reyes, M.D.
-
Martita Marcano Perez, M.D.
-
Mitzy Mattei Rivera, APRN
-
Fouad Sam Moursi, MD
-
Rafael A Pagan Medina, M.D.
-
Claudia Palmer, FNP-BC
-
Jessy Pierre-Louis, D.P.M.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Federally qualified health center certification: CCN 681178
- Legal name
- CENTRAL FLORIDA HEALTH CARE INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 8, 2020
- Last certification
- Jun 8, 2020
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 5, 1953 in FL
- Enrollment address
- 1417 Lakeland Hills Blvd
Ste 101
Lakeland, FL 33805-3200
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Central Florida Health Care Inc |
5% Or Greater Direct Ownership Interest | May 11, 2020 | |
| Jennings Brinson |
Corporate Director |
Aug 11, 2017 | |
| Tina Solomon |
Corporate Officer |
Apr 15, 2019 | |
| W-2 Managing Employee |
Apr 15, 2019 | ||
| Operational/Managerial Control |
Apr 15, 2019 | ||
| Cara Roseanne Nelson-James |
Contracted Managing Employee |
Dec 1, 2019 | |
| Corporate Officer |
Dec 1, 2019 | ||
| Nicholas a Emanuel |
Corporate Director |
May 27, 2008 | |
| Beth Luxford |
Corporate Director |
Jan 27, 2020 | |
| Ann M Claussen |
Corporate Officer |
Jan 1, 2014 | |
| W-2 Managing Employee |
Jan 1, 2014 | ||
| Operational/Managerial Control |
Jan 1, 2014 | ||
| Karen McKenzie |
Corporate Officer |
Jan 8, 2021 | |
| Lawrence Best |
Corporate Officer |
Jul 25, 2017 | |
| Operational/Managerial Control |
Jul 25, 2017 | ||
| Andrew N Hein |
Corporate Officer |
Jul 1, 2012 | |
| Operational/Managerial Control |
Jul 1, 2012 | ||
| Barbara Turner |
Corporate Officer |
May 5, 2014 | |
| Operational/Managerial Control |
May 5, 2014 | ||
| Nasseam McPherson James |
Corporate Director | Jun 21, 2016 | |
| Philip Kenney |
Contracted Managing Employee |
Jan 11, 2016 | |
| Corporate Officer |
Jan 11, 2016 |
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| Central Florida Health Care, Inc.-Frostproof |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 1994 |
| Central Florida Health Care Inc |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Sep 30, 2016 |
| Central Florida Health Care Inc |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Jan 1, 2020 |
| Central Florida Health Care Inc |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Aug 1, 2016 |
| Central Florida Health Care Inc |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| Central Florida Health Care Inc |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 2, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200608002604 | FL | Part a Provider - Federally Qualified Health Center (FQHC) | 0143127951 | Practice locations: Lakeland, FL |
National Provider Directory
- Tax ID family
- Central Fla HLTH Care L
- Part of
- Central Fla HLTH Care L
Locations
1417 Lakeland Hills Blvd
Ste 101
Lakeland, FL 33805
Phone (863) 229-7970
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1417 Lakeland Hills Blvd Ste 101
Lakeland, FL 33805-3200
Mailing address
47 5TH St NW
Winter Haven, FL 33881-4672
Phone (863) 291-5110
Other names
- Central Florida Health Care- Lakeland Hills Dental
Other providers in Lakeland, FL
- Central Florida Health Care Inc
- Central Florida Health Care Inc
- Central Florida Health Care, Inc.
- Central Florida Health Care, Inc.
- Central Florida Health Care, Inc.
- Central Florida Health Care, Inc.
- Central Florida Health Care, Inc.
- Central Florida Health Care, Inc.
- Central Florida Health Care, Inc.
- Central Florida Health Care, Inc.
All providers in Lakeland, FL · Federally Qualified Health Center (FQHC) in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.