Pedim Outreach and Specialty Clinic LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PEDIM OUTREACH AND SPECIALTY CLINIC LLC

Practice address

3565 E Suzie LN
Inverness, FL 34452-3250

Phone

(352) 527-6888

NPI assigned

Apr 24, 2023

Last updated

Feb 13, 2025By 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

Dacelin St Martin, MDNPI 1457392136

Title

Owner

Phone

(352) 684-8736

Specialties & licenses 3

Addresses

Other names 1

• PEDIM Outreach Inverness Other name

Tax ID family

Pedim Outreach and Specialty Clinic LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Pedim Outreach and Specialty Clinic LLC

  • Family Medicine Physician
  • Lecanto, FL
  • NPI 1558128819
  NPD tax ID

Practitioners 1

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.

• Dacelin St Martin, MD

  • Internal Medicine Physician
  • Lecanto, FL
  • NPI 1457392136
  NPD (past) Authorized official

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

{
    "created_epoch": "1682294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1710674205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2066",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344602066",
            "telephone_number": "352-634-8736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3565 E SUZIE LN",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344523250",
            "telephone_number": "352-527-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIM OUTREACH AND SPECIALTY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-24",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A",
        "authorized_official_last_name": "ST MARTIN",
        "authorized_official_first_name": "DACELIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-684-8736",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEDIM Outreach Inverness",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Pritiben Patel, RDN
• Teresa Carol Patterson, DO
• Taylor Payne
• Pediatric and Internal Medicine Specialists Inc (PedIM Healthcare)
• Pediatrix Medical Group of Florida Inc
• Janeen Pernigotti
• Walter Haney Perrell III, FNP-C
• Elyse Marie Perry, ARNP
• Ashley Nichole Petrie, APRN
• Charles Petrosky

• Internal Medicine Physician in Inverness, FL
• Providers in Inverness, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; 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.