NPIMap

Individual provider Active NPI

Jacqueline Dimalanta Poletes, APRN

  • Family Nurse Practitioner
  • Sun City Center, FL
National Provider Identifier
1699308874
Registry record updated Aug 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11006160 Issued in FL
Practice address
953 E del Webb Blvd
Sun City Center, FL 33573-6669
Phone
(813) 634-6880
Fax
(813) 634-6833
NPI assigned
Feb 17, 2020
Last updated
Aug 27, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN11006160 FL Primary

Addresses

Primary practice location

953 E del Webb Blvd
Sun City Center, FL 33573-6669

Mailing address

2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774

Other identifiers 2

IdentifierTypeStateIssuer
Y3VPJOtherFLBCBS
MC081OtherFLMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200325001665 FL Practitioner - Nurse Practitioner 3274961222 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians

Practice addresses (Care Compare)

953 Del Webb Blvd E
Sun City Center, FL 33573-6669
Phone (813) 634-6880

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11006160FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC CurrentSince Mar 30, 2020 Accepting new patients
Millennium Physician Group LLC CurrentSince Mar 30, 2020 Accepting new patients
Jonathan Alvior MD LLC PastSince Feb 1, 2020 Accepting new patients

Locations

2675 Winkler Ave
Fl 2
Fort Myers, FL 33901
Phone (855) 979-5700

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

953 E Del Webb Blvd
Sun City Ctr, FL 33573
Phone (813) 634-6880

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: jacqueline.poletes.1@4290.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598486400000",
    "number": "1699308874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "953 E DEL WEBB BLVD",
            "city": "SUN CITY CENTER",
            "state": "FL",
            "postal_code": "335736669",
            "telephone_number": "813-634-6880",
            "fax_number": "813-634-6833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLETES",
        "first_name": "JACQUELINE",
        "middle_name": "DIMALANTA",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-17",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11006160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y3VPJ",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "MC081",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sun City Center, FL

Sources for this page

Verify at the official NPI Registry.