NPIMap

Organization Active NPI

Family Care Center, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tampa, FL
National Provider Identifier
1689441255
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
FAMILY CARE CENTER, LLC
Practice address
4300 W Cypress St Ste 825
Tampa, FL 33607-4253
Phone
(719) 540-2100
NPI assigned
Dec 5, 2023
Last updated
Dec 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

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

Authorized official

Name
Christian M Ellis
Title
Provider Engagement & Credentialing
Phone
(765) 540-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

4300 W Cypress St Ste 825
Tampa, FL 33607-4253

Mailing address

2860 S Circle Dr Ste 109
Colorado Springs, CO 80906-4195
Phone (719) 540-2100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240422001047 FL Part B Supplier - Clinic/Group Practice 5991064420 Receives reassigned benefits from 12 practitioners
Practice locations: Tampa, FL

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory

Locations

4300 W Cypress St
Ste 825
Tampa, FL 33607

Practitioners & affiliated clinicians

Practitioners 12

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": "1701734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701734400000",
    "number": "1689441255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2860 S CIRCLE DR STE 109",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064195",
            "telephone_number": "719-540-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 W CYPRESS ST STE 825",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336074253",
            "telephone_number": "719-540-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-05",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROVIDER ENGAGEMENT & CREDENTIALING",
        "authorized_official_telephone_number": "765-540-2100"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; 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.