NPIMap

Organization Active NPI

PSG of Sarasota LLC

  • Home Infusion Therapy Pharmacy
  • Raleigh, NC
National Provider Identifier
1679250443
Registry record updated Jan 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
Legal business name
PSG OF SARASOTA LLC
Practice address
140 Northway CT
Raleigh, NC 27615-4916
Phone
(844) 650-5802
Fax
(844) 277-0049
NPI assigned
Jul 3, 2023
Last updated
Jan 8, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PSG OF SARASOTA LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 8, 2025

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

Authorized official

Name
Victoria Lynn Starr
Title
Coo
Phone
(844) 650-5802

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X NU
Home Infusion Therapy Pharmacy 3336H0001X NU Primary
Specialty Pharmacy 3336S0011X NU

Addresses

Primary practice location

140 Northway CT
Raleigh, NC 27615-4916

Mailing address

5315 Avion Park Dr Ste 120
Tampa, FL 33607-1461
Phone (844) 650-5802

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments
Home infusion therapy
Medicare-enrolled home infusion therapy supplier

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240424002894 NC Part B Supplier - Home Infusion Therapy Supplier 7810379138 Practice locations: Raleigh, NC
O20241114000614 NC DME Supplier - Pharmacy 7810379138 Practice locations: Raleigh, NC

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Premium RX Pharmacy6 organizations share this tax ID, including this one
Part of
Premium RX Pharmacy

Other organizations with this tax ID 5

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

Locations

5315 Avion Park Dr
Ste 120
Tampa, FL 33607
Phone (727) 209-5722

NPI Registry JSON

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

{
    "created_epoch": "1688342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736294400000",
    "number": "1679250443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5315 AVION PARK DR STE 120",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336071461",
            "telephone_number": "844-650-5802",
            "fax_number": "844-277-0049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 NORTHWAY CT",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276154916",
            "telephone_number": "844-650-5802",
            "fax_number": "844-277-0049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSG OF SARASOTA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PSG OF SARASOTA LLC",
        "enumeration_date": "2023-07-03",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A",
        "authorized_official_last_name": "STARR",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "844-650-5802"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; 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.