NPIMap

Organization Active NPI

Tradition Health and Wellness Clinic PLLC

Doing business as Blue Skies Health & Wellness Clinic

  • Family Medicine Physician
  • Port St Lucie, FL
National Provider Identifier
1720840168
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TRADITION HEALTH AND WELLNESS CLINIC PLLC
Doing business as
Blue Skies Health & Wellness Clinic
Practice address
10198 SW Village Pkwy Ste 105
Port St Lucie, FL 34987-2592
Phone
(772) 934-4990
Fax
(772) 934-4991
NPI assigned
Jan 30, 2024
Last updated
Apr 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Authorized official

Name
Sabrina Lynn Vizzini, PANPI 1912218454
Title
Ceo
Phone
(772) 934-4990

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
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

10198 SW Village Pkwy Ste 105
Port St Lucie, FL 34987-2592

Mailing address

10198 SW Village Pkwy Ste 105
Port St Lucie, FL 34987-2592
Phone (772) 934-4990

Other names 1

  • Blue Skies Health & Wellness Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240412001175 FL Part B Supplier - Clinic/Group Practice 8224477013 Receives reassigned benefits from 11 practitioners
Practice locations: Port St Lucie, 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
10D2308431Blue Skies Health & Wellness Clinic10198 SW Village Pkwy Ste 105, Port Saint Lucie, FL 34987Certificate of waiverJul 28, 2028

National Provider Directory

National Provider Directory

Locations

10198 SW Village Pkwy
Port Saint Lucie, FL 34987
Phone (772) 879-8700

10198 SW Village Pkwy
Ste 105
Port St Lucie, FL 34987
Phone (772) 934-4990

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1706572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1720840168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10198 SW VILLAGE PKWY STE 105",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872592",
            "telephone_number": "772-934-4990",
            "fax_number": "772-934-4991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10198 SW VILLAGE PKWY STE 105",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872592",
            "telephone_number": "772-934-4990",
            "fax_number": "772-934-4991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRADITION HEALTH AND WELLNESS CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-30",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "VIZZINI",
        "authorized_official_first_name": "SABRINA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "772-934-4990",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Skies Health & Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blue Skies Health & Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; 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.