Mission Family Medicine LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MISSION FAMILY MEDICINE LLC

Practice address

1785 Garden St
Titusville, FL 32796-3221

Phone

(321) 269-9612

Fax

(321) 269-8433

NPI assigned

Oct 4, 2021

Organization subpart

No

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

Authorized official

Name

Katie Fontaine

Title

Administrator

Phone

(321) 269-9612

Specialties & licenses 1

Addresses

Other names 1

• Mission Family Medicine LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24331/brand/1/csg/1/fhir/r4

Practitioners 6

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

• Benjamin Grant Marshall, M.D.

  • Family Medicine Physician
  • Titusville, FL
  • NPI 1922369859
  Medicare reassignment Care Compare group NPD
• Miranda B Marshall, M.D.

  • Family Medicine Physician
  • Titusville, FL
  • NPI 1083973689
  Medicare reassignment Care Compare group NPD
• Renee Lok-Yee Wong Soucier, MD

  • Family Medicine Physician
  • Titusville, FL
  • NPI 1972088631
  Medicare reassignment Care Compare group NPD
• Kylie Woodhouse, APRN

  • Family Nurse Practitioner
  • Titusville, FL
  • NPI 1093415903
  Medicare reassignment Care Compare group NPD
• Matthew Tsampico Baker, PA-C

  • Physician Assistant
  • New Smyrna Beach, FL
  • NPI 1255789392
  Medicare reassignment Care Compare group
• McKayla Michaud, PA-C

  • Family Medicine Physician
  • Titusville, FL
  • NPI 1992396121
  Medicare reassignment NPD

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

{
    "created_epoch": "1633305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1699447086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1785 GARDEN ST",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327963221",
            "telephone_number": "321-269-9612",
            "fax_number": "321-269-8433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1785 GARDEN ST",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327963221",
            "telephone_number": "321-269-9612",
            "fax_number": "321-269-8433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-04",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A",
        "authorized_official_last_name": "FONTAINE",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "321-269-9612"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mission Family Medicine LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michele Harrington LCSW Inc
• Miguel a Medina MD PA
• Heith A Miller, D.C.
• Jada Janielle Miller
• Sarah Milliken, CCC-SLP
• Lindsey Anne Mitchell
• Christina Moccio
• Kiran R Modi, M.D.
• Naresh V Mody, M.D.
• Claudine Marie Mogg, CNA

• Family Medicine Physician in Titusville, FL
• Providers in Titusville, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.