NPIMap

Organization Active NPI

Primary Care Medical Services of Poinciana Inc

  • Federally Qualified Health Center (FQHC)
  • Kissimmee, FL
National Provider Identifier
1710375456
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY CARE MEDICAL SERVICES OF POINCIANA INC
Practice address
109 N Doverplum Ave
Kissimmee, FL 34758
Phone
(407) 943-8600
NPI assigned
Jan 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Authorized official

Name
Belinda Johnson-Cornett
Title
Ceo
Phone
(407) 943-8600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

109 N Doverplum Ave
Kissimmee, FL 34758

Mailing address

1503 Bill Beck Blvd
Kissimmee, FL 34744-9516
Phone (407) 943-8600

Other identifiers 1

IdentifierTypeStateIssuer
000835600MedicaidFL

Other names 1

  • Osceola Community Health Services at Poincian Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170807001413 FL Part A Provider - Federally Qualified Health Center (FQHC) 4486923059 Practice locations: Kissimmee, FL

Federally qualified health center certification: CCN 101126

Legal name
PRIMARY CARE MEDICAL SERVICES OF POINCIANA INC
Doing business as
OSCEOLA COMMUNITY HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 7, 2017
Last certification
Aug 7, 2017
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 2017 in FL
Enrollment address
109 N Doverplum Ave
Ochs Poinciana
Kissimmee, FL 34758-3309

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Primary Care Medical Services of Poinciana Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Cynthia Diaz Individual Corporate OfficerCfo Jan 1, 2021
W-2 Managing Employee Sep 6, 2017
Magaly Guzman Individual W-2 Managing EmployeeAdministrative Assistant Apr 1, 2017
Sally Sera Individual Corporate DirectorBoard Member Apr 1, 2017
Belinda Johnson Cornett Individual Corporate OfficerCeo Apr 1, 2017
W-2 Managing EmployeeCeo Apr 1, 2017 5%

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Osceola Community Health Services in BVLKissimmee, FL, CCN 681125 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2017
Osceola Community Health Services at Cameron PreserveKissimmee, FL, CCN 101018 Federally qualified health center Operational/Managerial Control Sep 30, 2019

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1710375456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 BILL BECK BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347449516",
            "telephone_number": "407-943-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N DOVERPLUM AVE",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34758",
            "telephone_number": "407-943-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE MEDICAL SERVICES OF POINCIANA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-05",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-CORNETT",
        "authorized_official_first_name": "BELINDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "407-943-8600"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000835600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Osceola Community Health Services at Poincian",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Osceola Community Health Services at Poincian",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.