Florida Heart & Vascular Multi Specialty Group PA

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

Legal business name

FLORIDA HEART & VASCULAR MULTI SPECIALTY GROUP PA

Practice address

511 Medical Plaza Dr
Suite 101
Leesburg, FL 34748-7326

Phone

(352) 728-6808

Fax

(352) 728-1743

NPI assigned

Aug 31, 2005

Last updated

Sep 13, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jackie Faunda

Title

Physician Credentialing

Phone

(352) 728-6808

Specialties & licenses 9

Addresses

Other identifiers 6

Other names 1

• Florida Heart & Vascular Center Other name

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Orlando Health Network Inc

  • Surgery Physician
  • Longwood, FL
  • NPI 1942483805

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379030400000",
    "number": "1699769042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 MEDICAL PLAZA DR",
            "address_2": "SUITE 101",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347487326",
            "telephone_number": "352-728-6808",
            "fax_number": "352-728-1743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 MEDICAL PLAZA DR",
            "address_2": "SUITE 101",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347487326",
            "telephone_number": "352-728-6808",
            "fax_number": "352-728-1743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA HEART & VASCULAR MULTI SPECIALTY GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-31",
        "last_updated": "2013-09-13",
        "status": "A",
        "authorized_official_last_name": "FAUNDA",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "PHYSICIAN CREDENTIALING",
        "authorized_official_telephone_number": "352-728-6808"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FLORIDA",
            "identifier": "21798",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GBA RR PALMETTO",
            "identifier": "CN9333",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "7914953",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAILHANDLERS",
            "identifier": "773114",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "695956",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255260400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida Heart & Vascular Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Florida Cardiovascular Specialists LLC
• Florida Cardiovascular Specialists PA
• Florida Clinical Practice Association (UF Health Orthopaedics Leesburg)
• Florida Heart & Vascular Multi Specialty Clinic
• Florida Heart & Vascular Multi Specialty Group PA
• Florida Heart & Vascular Multi Specialty Group, PA (Fredric M. Davis,DO)
• Florida Heart & Vascular Multi Specialty Group, PA (Central Florida Associated Primary Care Physicians)
• Florida Heart & Vascular Multi Specialty Group, PA (Leesburg Family Medicine)
• Florida Heart & Vascular Multi Specialty Group, PA (Frank B. Pellegrino, MD)
• Florida Heart & Vascular Multi Specialty Group, PA (Maria B. Bello, MD)

• Cardiovascular Disease Physician in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Cardiovascular Disease Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.