NPIMap

Organization Active NPI

Physio Med Inc

  • Rehabilitation Clinic/Center
  • Eustis, FL
National Provider Identifier
1720096720
Registry record updated Feb 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
PHYSIO MED INC
Practice address
2765 S Bay St
Eustis, FL 32726-6501
Phone
(352) 589-5955
Fax
(352) 589-5747
NPI assigned
Aug 4, 2006
Last updated
Feb 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2022

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

Authorized official

Name
Scottie BullNPI 1740311588
Title
President
Phone
(352) 589-5595

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
Rehabilitation Clinic/Center 261QR0400X NU Primary

Addresses

Primary practice location

2765 S Bay St
Eustis, FL 32726-6501

Mailing address

2765 S Bay St
Eustis, FL 32726-6501
Phone (352) 589-5595

Other identifiers 2

IdentifierTypeStateIssuer
72890070OtherAETNA
Q3NOtherFLBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030924000032 FL Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 7911818950 Practice locations: Eustis, FL; Lady Lake, FL; Leesburg, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720096720. Details of each certification follow.

  • CCN 686515 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 686515

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PHYSIO MED INC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Aug 25, 1997
Last certification
Jan 21, 2025
Ownership / control type
Proprietary
Facility address
2765 S Bay St
Eustis, FL 32726

National Provider Directory

National Provider Directory
Tax ID family
Heather Rush2 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.

Locations

2765 S Bay St
Eustis, FL 32726
Phone (352) 589-5955

443 Plaza Dr
Eustis, FL 32726
Phone (352) 589-5539

765 Highway 466
Lady Lake, FL 32159
Phone (352) 259-2522

920 Rolling Acres Rd
Lady Lake, FL 32159

1127 E North Blvd
Leesburg, FL 34748
Phone (352) 365-1114

734 N 3rd St
Ste 105
Leesburg, FL 34748
Phone (352) 835-0848

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643760000000",
    "number": "1720096720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2765 S BAY ST",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327266501",
            "telephone_number": "352-589-5595",
            "fax_number": "352-589-5747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2765 S BAY ST",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327266501",
            "telephone_number": "352-589-5955",
            "fax_number": "352-589-5747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSIO MED INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A",
        "authorized_official_last_name": "BULL",
        "authorized_official_first_name": "SCOTTIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-589-5595"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "72890070",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Q3N",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eustis, FL

Sources for this page

Verify at the official NPI Registry.