Sun 'N Lake Medical Group,PA

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

SUN 'N LAKE MEDICAL GROUP,PA

Practice address

4958 Sun N Lake Blvd
Sebring, FL 33872-2167

Phone

(863) 385-8004

Fax

(863) 385-2330

NPI assigned

Jun 22, 2007

Organization subpart

No

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

Authorized official

Name

Miguel F Beltre, M.DNPI 1740270545

Title

President

Phone

(863) 385-2659

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

Rural health clinic certification: CCN 108950

Legal name

SUN 'N LAKE MEDICAL GROUP,PA

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Feb 27, 2003

Last certification

Aug 2, 2023

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Jan 1, 2001 in FL

Enrollment address

4958 Sun N Lake Blvd
Sebring, FL 33872-2167

Other NPIs with the same Medicare PAC ID 1

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

• Sun 'N Lake Medical Group,PA

  • Rural Health Clinic/Center
  • Lake Placid, FL
  • NPI 1144400540

  2668380841

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Miguel F Beltre, M.D

  • Internal Medicine Physician
  • Sebring, FL
  • NPI 1740270545

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership

Practitioners 10

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

• Miguel F Beltre, M.D

  • Internal Medicine Physician
  • Sebring, FL
  • NPI 1740270545
  Medicare reassignment NPD Authorized official
• Adriana Haralson, PA-C

  • Physician Assistant
  • Maitland, FL
  • NPI 1245788967
  Medicare reassignment NPD
• Sierra Melissa Pautke, APRN

  • Primary Care Nurse Practitioner
  • Sebring, FL
  • NPI 1215508924
  Medicare reassignment NPD
• Jennyfer Poveda, PA-C

  • Physician Assistant
  • West Palm Beach, FL
  • NPI 1720676539
  Medicare reassignment NPD
• Tina Yang

  • Physician Assistant
  • Sebring, FL
  • NPI 1376366997
  Medicare reassignment NPD
• Terri Pam Allred, A.R.N.P.

  • Family Nurse Practitioner
  • Sebring, FL
  • NPI 1689633836
  NPD (past)
• Raisa D Camilo, M.D

  • Pediatrics Physician
  • Sebring, FL
  • NPI 1427048495
  NPD (past)
• Taja Brie Ana Farhi, PA-C

  • Physician Assistant
  • Miami, FL
  • NPI 1518596964
  NPD (past)
• Monica Lopez Quiles, APRN

  • Family Nurse Practitioner
  • Sebring, FL
  • NPI 1295517084
  NPD (past)
• Renuka Deonarinesingh, PA

  • Medical Physician Assistant
  • Tacoma, WA
  • NPI 1932421989
  NPD (past)

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

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377129600000",
    "number": "1639375165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4958 SUN N LAKE BLVD",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338722167",
            "telephone_number": "863-385-8004",
            "fax_number": "863-385-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4958 SUN N LAKE BLVD",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338722167",
            "telephone_number": "863-385-8004",
            "fax_number": "863-385-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN 'N LAKE MEDICAL GROUP,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-22",
        "last_updated": "2013-08-22",
        "status": "A",
        "authorized_official_last_name": "BELTRE",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "863-385-2659",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1104923374",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "373302500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1740270545",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1760505457",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1467461905",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1427048495",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "373963500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charleen Kay Stroup, LMHC, LPN, CAP, BCPC
• Saurabh Sujanyal, MD
• Megan Virginia Sullivan, PTA
• Nazia Sultana, M.D.
• Summit PT, PLLC
• Sun Health and Wellness, Inc (First Choice Specialty Pharmacy)
• Sundance Therapy Inc.
• Sunny Autism Home Care LLC
• Sunny Hills Alf of Sebring Inc
• Sunnyvale Medical Transport LLC

• Rural Health Clinic/Center in Sebring, FL
• Providers in Sebring, FL by specialty
• Rural Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.