Gulf Coast Orthotics & Prosthetics Center, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

POR181 Issued in FL

Legal business name

GULF COAST ORTHOTICS & PROSTHETICS CENTER, LLC

Practice address

21300 Gertrude Ave
Port Charlotte, FL 33952-5002

Phone

(941) 408-6246

Fax

(941) 249-8956

NPI assigned

Feb 4, 2014

Organization subpart

No

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

Authorized official

Name

Mrs. Lilliane M Roderiques

Title

Owner

Phone

(941) 408-6246

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Gulf Coast Orthotics & Prosthetics Center, LLC

  • Prosthetic/Orthotic Supplier
  • Venice, FL
  • NPI 1538355250

  5698971356

  Same PAC ID

These 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

Tax ID family

Gulf Coast Orthotics Prosthetics Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Gulf Coast Orthotics & Prosthetics Center, LLC

  • Prosthetic/Orthotic Supplier
  • Venice, FL
  • NPI 1538355250
  NPD tax ID

Locations

Networks

• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

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

{
    "created_epoch": "1391472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395360000000",
    "number": "1588087001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21300 GERTRUDE AVE",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21300 GERTRUDE AVE",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525002",
            "telephone_number": "941-408-6246",
            "fax_number": "941-249-8956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST ORTHOTICS & PROSTHETICS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-04",
        "last_updated": "2014-03-21",
        "status": "A",
        "authorized_official_last_name": "RODERIQUES",
        "authorized_official_first_name": "LILLIANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-408-6246",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "POR181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0324051 00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gulf Coast Anesthesia Inc.
• Gulf Coast Chiropractic Center, P.a.
• Gulf Coast Emergency Physicians PA
• Gulf Coast Hearing Aid Centers Inc.
• Gulf Coast Knee Scooter
• Gulf Coast Pulmonary Medicine
• Gulf Coast Pulmonary Medicine P.a.
• Gulf Coast Sleep Solutions LLC
• Gulf Coast Therapy Associates, P.a.
• Gulf-to-Bay Anesthesiology Associates LLC

• Durable Medical Equipment & Medical Supplies in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2014; 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.