First Coast Obstetrics and Gynecology PA

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

FIRST COAST OBSTETRICS AND GYNECOLOGY PA

Practice address

6100 Saint Johns Ave
Suite 6
Palatka, FL 32177

Phone

(386) 325-5699

NPI assigned

Mar 24, 2011

Last updated

Sep 21, 2018By 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

Dr. Lucien - Maximin Yanou Tchuisse, M.D.NPI 1174591820

Title

President

Phone

(386) 325-5699

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710286067. Details of each certification follow.

• CCN 683815 Rural health clinic · Active · Details

Rural health clinic certification: CCN 683815

Legal name

FIRST COAST OBSTETRICS AND GYNECOLOGY PA

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Oct 9, 2014

Last certification

Sep 10, 2020

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Mar 1, 2011 in FL

Enrollment address

7000 Old Wolf Bay Rd
Palatka, FL 32177-6816

Locations

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Lucien-Maximin Yanou Tchuisse, M.D.

  • Obstetrics & Gynecology Physician
  • Palatka, FL
  • NPI 1174591820

  5% Or Greater Direct Ownership Interest, Corporate Officer, W-2 Managing Employee

  CMS ownership

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lucien-Maximin Yanou Tchuisse, M.D.

  • Obstetrics & Gynecology Physician
  • Palatka, FL
  • NPI 1174591820
  Medicare reassignment Care Compare group Authorized official
• Alyn McGee, ARNP, CNM

  • Advanced Practice Midwife
  • Orlando, FL
  • NPI 1467512814
  Medicare reassignment Care Compare group NPD
• Connie Marie Gellinger, APRN CNM

  • Advanced Practice Midwife
  • Palatka, FL
  • NPI 1497458533
  Medicare reassignment NPD
• Wendy Pauline Cox, ARNP, FNP-BC

  • Obstetrics & Gynecology Nurse Practitioner
  • Palatka, FL
  • NPI 1871981316
  NPD (past)
• Rhonda Michelle Sargent, APRN CNM

  • Obstetrics & Gynecology Nurse Practitioner
  • Palatka, FL
  • NPI 1841014735
  NPD (past)

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

{
    "created_epoch": "1300924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537488000000",
    "number": "1710286067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 SAINT JOHNS AVE STE 6",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321776859",
            "telephone_number": "386-325-5699",
            "fax_number": "386-325-5644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 SAINT JOHNS AVE",
            "address_2": "SUITE 6",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "32177",
            "telephone_number": "386-325-5699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST COAST OBSTETRICS AND GYNECOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-24",
        "last_updated": "2018-09-21",
        "status": "A",
        "authorized_official_last_name": "TCHUISSE",
        "authorized_official_first_name": "LUCIEN - MAXIMIN",
        "authorized_official_middle_name": "YANOU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-325-5699",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stylesha Shymeka Fields, CNA
• Errol Norman Findlater, M.D.
• First Care Inc
• First Choice Pharmacy LLC
• First Coast Cardiovascular Institute, LLC
• Ramonica Flagler, NP
• James A. Fleming
• Florida Cancer Specialists & Research Institute, LLC
• Florida Department of Health
• Florida Therapeutic Massage

• Obstetrics & Gynecology Physician in Palatka, FL
• Providers in Palatka, FL by specialty
• Obstetrics & Gynecology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.