Organization Active NPI

Lake Mary Family Care P a

  • Family Medicine Physician
  • Lake Mary, FL
National Provider Identifier
1649346826
Registry record updated Jun 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME81907 Issued in FL
Legal business name
LAKE MARY FAMILY CARE P A
Practice address
2500 W Lake Mary Blvd
Suite 217
Lake Mary, FL 32746-3501
Phone
(407) 688-8862
Fax
(407) 688-8868
NPI assigned
Nov 28, 2006
Last updated
Jun 29, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2011

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

Authorized official

Name
Michael E Dillehay, MDNPI 1811000888
Title
President
Phone
(407) 688-8862

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 ME81907 FL Primary

Addresses

Primary practice location

2500 W Lake Mary Blvd
Suite 217
Lake Mary, FL 32746-3501

Mailing address

2500 W Lake Mary Blvd
Suite 217
Lake Mary, FL 32746-3501
Phone (407) 688-8862

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070608000450 FL Part B Supplier - Clinic/Group Practice 3971600024 Receives reassigned benefits from 6 practitioners
Practice locations: Lake Mary, FL; Longwood, FL

National Provider Directory

National Provider Directory

Locations

2500 W Lake Mary Blvd
Ste 206
Lake Mary, FL 32746
Phone (407) 333-1212

2500 W Lake Mary Blvd
Ste 217
Lake Mary, FL 32746
Phone (407) 444-5225

Practitioners & affiliated clinicians

Practitioners 8

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": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309305600000",
    "number": "1649346826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 W LAKE MARY BLVD",
            "address_2": "SUITE 217",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463501",
            "telephone_number": "407-688-8862",
            "fax_number": "407-688-8868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 W LAKE MARY BLVD",
            "address_2": "SUITE 217",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463501",
            "telephone_number": "407-688-8862",
            "fax_number": "407-688-8868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MARY FAMILY CARE P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2011-06-29",
        "status": "A",
        "authorized_official_last_name": "DILLEHAY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-688-8862",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME81907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.