NPIMap

Organization Active NPI

Macdermott Group, LLC

  • Nurse Practitioner
  • Kissimmee, FL
National Provider Identifier
1689902199
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
MACDERMOTT GROUP, LLC
Practice address
2940 Mallory Cir Ste 205
Kissimmee, FL 34747-1818
Phone
(407) 507-6976
NPI assigned
Nov 20, 2009
Organization subpart
Yes
Parent organization
MACDERMOTT GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Authorized official

Name
Dr. Jeremy Good, D.C.NPI 1669632253
Title
Chiropractor
Phone
(843) 697-6994

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Clinic/Center 261Q00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

2940 Mallory Cir Ste 205
Kissimmee, FL 34747-1818

Mailing address

2940 Mallory Cir Ste 205
Kissimmee, FL 34747-1818
Phone (407) 507-6976

Other identifiers 2

IdentifierTypeStateIssuer
1689902199OtherFLGROUP NPI
2201BOtherFLBCBS

Other names 1

  • Orlando Resorts Spine & Body Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091229000030 FL Part B Supplier - Clinic/Group Practice 3072653971 Receives reassigned benefits from 7 practitioners
Practice locations: Celebration, FL

National Provider Directory

National Provider Directory
Part of
Macdermott Group LLC

Locations

2940 Mallory Cir
Ste 205
Kissimmee, FL 34747
Phone (407) 507-6976

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1258675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717459200000",
    "number": "1689902199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 MALLORY CIR STE 205",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347471818",
            "telephone_number": "407-507-6976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 MALLORY CIR STE 205",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347471818",
            "telephone_number": "407-507-6976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACDERMOTT GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MACDERMOTT GROUP, LLC",
        "enumeration_date": "2009-11-20",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A",
        "authorized_official_last_name": "GOOD",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "843-697-6994",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1689902199",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2201B",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orlando Resorts Spine & Body",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; 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.