Premium Primary Care & Walk-in Clinic Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PREMIUM PRIMARY CARE & WALK-IN CLINIC INC

Practice address

1801 SE Hillmoor Dr Unit a-107P
Port St Lucie, FL 34952-7553

Phone

(772) 446-0950

Fax

(772) 446-0956

NPI assigned

Dec 15, 2023

Organization subpart

No

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

Authorized official

Name

Patrick A Vergel de DiosNPI 1760993786

Title

Aprn

Phone

(772) 446-0950

Specialties & licenses 1

Addresses

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

Practitioners 2

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

• Patrick Aquino Vergel de Dios, ARNP, FNP-C

  • Family Nurse Practitioner
  • Port St Lucie, FL
  • NPI 1760993786
  Medicare reassignment NPD Authorized official
• Srinivas S Boppana, D.O.

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1679839252

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1702598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702598400000",
    "number": "1700654167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 SE HILLMOOR DR UNIT A-107P",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527553",
            "telephone_number": "772-446-0950",
            "fax_number": "772-446-0956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 SE HILLMOOR DR UNIT A-107P",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527553",
            "telephone_number": "772-446-0950",
            "fax_number": "772-446-0956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM PRIMARY CARE & WALK-IN CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-15",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A",
        "authorized_official_last_name": "VERGEL DE DIOS",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "APRN",
        "authorized_official_telephone_number": "772-446-0950"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premier Surgical Assisting LLC
• Premier Wellness Centers East LLC
• Premier Wellness Centers LLC
• Premier Wellness Centers PSL
• Premise Health of Florida Medical PA
• Susan M Prendergast, ARNP
• Deanna Presti, PT
• Linda Prevalon
• Stefan G Pribil, MD
• Debra Price, AGNP-C

• Family Medicine Physician in Port St Lucie, FL
• Providers in Port St Lucie, 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 Dec 15, 2023; 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.