NPIMap

Organization Active NPI

Physician Providers Group PA

  • Specialist
  • Inverness, FL
National Provider Identifier
1720073216
Registry record updated Jul 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PHYSICIAN PROVIDERS GROUP PA
Practice address
305 S Line Ave
Inverness, FL 34452-4605
Phone
(352) 344-4791
Fax
(352) 344-3822
NPI assigned
Sep 12, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2023

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

Authorized official

Name
Robert Ulseth, MDNPI 1043205305
Title
MD/Owner
Phone
(352) 344-4791

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

305 S Line Ave
Inverness, FL 34452-4605

Mailing address

PO Box 1925
Lady Lake, FL 32158-1925
Phone (523) 553-4075

Other identifiers 1

IdentifierTypeStateIssuer
34759OtherFLBLUE SHIELD PROV #

Other names 1

  • COMPREHENSIVE PAIN MANAGEMENT CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040513000180 FL Part B Supplier - Clinic/Group Practice 9931199940 Receives reassigned benefits from 9 practitioners
Practice locations: Inverness, FL; Ocala, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2003928Comprehensive Pain Management305 S Line Ave, Inverness, FL 34452Certificate of waiverFeb 21, 2028

National Provider Directory

National Provider Directory

Locations

304 S Citrus Ave
Inverness, FL 34452
Phone (352) 344-4791

305 S Line Ave
Inverness, FL 34452
Phone (352) 344-4791

2685 SW 32nd Pl
Ste 500
Ocala, FL 34471
Phone (352) 509-3045

2051 45th St
Ste 108
West Palm Beach, FL 33407
Phone (561) 845-7432

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688342400000",
    "number": "1720073216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1925",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321581925",
            "telephone_number": "523-553-4075",
            "fax_number": "888-770-3208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 S LINE AVE",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344524605",
            "telephone_number": "352-344-4791",
            "fax_number": "352-344-3822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN PROVIDERS GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-12",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-03",
        "status": "A",
        "authorized_official_last_name": "ULSETH",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "352-344-4791",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROV #",
            "identifier": "34759",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COMPREHENSIVE PAIN MANAGEMENT CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COMPREHENSIVE PAIN MANAGEMENT CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Inverness, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 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.