NPIMap

Organization Active NPI

Watson Clinic LLP

  • Physical Medicine & Rehabilitation Physician
  • Lakeland, FL
National Provider Identifier
1669655155
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
WATSON CLINIC LLP
Practice address
1430 Lakeland Hills Blvd
Lakeland, FL 33805-3202
Phone
(863) 680-7700
NPI assigned
Dec 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Authorized official

Name
Mr. Jason Hirsbrunner
Title
Chief Executive Officer
Phone
(863) 680-7007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

1430 Lakeland Hills Blvd
Lakeland, FL 33805-3202

Mailing address

1430 Lakeland Hills Blvd
Lakeland, FL 33805-3202
Phone (863) 680-7700

Other identifiers 2

IdentifierTypeStateIssuer
880988700MedicaidFL
G25OtherFLBCBS

Other names 1

  • Watson Clinic LLP Center for Rehabilitative Medicine Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121106000598 FL DME Supplier - Physician - Physical and Rehabilitation 1456258979 Practice locations: Lakeland, FL

Other NPIs with the same Medicare PAC ID 6

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2058116Watson Clinic North Pediatrics1430 Lakeland Hills Blvd, Lakeland, FL 33805Certificate of waiverApr 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Watson Clinic Brandon P9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

Practitioners 366

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

View all 366

NPI Registry JSON

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

{
    "created_epoch": "1196985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1669655155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 LAKELAND HILLS BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053202",
            "telephone_number": "863-680-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 LAKELAND HILLS BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053202",
            "telephone_number": "863-680-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATSON CLINIC LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-07",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "HIRSBRUNNER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "863-680-7007",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "880988700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "G25",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Watson Clinic LLP Center for Rehabilitative Medicine",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Watson Clinic LLP Center for Rehabilitative Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; 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.