Family Care on Eustis Square PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA2446 Issued in FL

Legal business name

FAMILY CARE ON EUSTIS SQUARE PA

Practice address

1 W Park Ave
Eustis, FL 32726-2947

Phone

(352) 357-4629

Fax

(352) 357-9367

NPI assigned

Sep 1, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Keith R Hester, PA-CNPI 1447214952

Title

Owner

Phone

(352) 357-4629

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

Practitioners 2

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

• Keith Robertson Hester, PA-C

  • Medical Physician Assistant
  • Eustis, FL
  • NPI 1447214952
  Medicare reassignment Care Compare group Authorized official
• Joseph A Risko, DO

  • Internal Medicine Physician
  • Tavares, FL
  • NPI 1386685527
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248307200000",
    "number": "1659473833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W PARK AVE",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327262947",
            "telephone_number": "352-357-4629",
            "fax_number": "352-357-9367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 W PARK AVE",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327262947",
            "telephone_number": "352-357-4629",
            "fax_number": "352-357-9367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE ON EUSTIS SQUARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2009-07-23",
        "status": "A",
        "authorized_official_last_name": "HESTER",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-357-4629",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA2446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "K0951",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "259149900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eustis Senior Care Inc
• Kimberly Ann Evans, RN
• Jennifer Everland, PTA
• Excel Hospitality Group, LLC
• Rebecca Anne Fallucca Fails, DPT
• Flor Farinas, LMHC
• Amanda Jo Farley, M.ED, BCBA
• Tessa Bryn Farrell, PTA
• James Fernandes, D.C.
• Miranda Figueredo

• Medical Physician Assistant in Eustis, FL
• Providers in Eustis, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2009; 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.