Active NPI
Premium Medical Clinic PA
- Pediatrics Physician
- Orlando, FL
National Provider Identifier
1730407420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME97108
- Legal business name
- PREMIUM MEDICAL CLINIC PA
- Practice address
- 12211 Regency Village Dr
Suite 2
Orlando, FL 32821-7813 - Phone
- (407) 212-3060
- Fax
- (877) 644-7808
- NPI assigned
- May 6, 2010
- Last updated
- Feb 1, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Safaa Abdel-Al, M.D.
- Title
- President/Owner
- Phone
- (407) 212-3060
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME97108 | FL | Primary |
Addresses
Primary practice location
12211 Regency Village Dr
Suite 2
Orlando, FL 32821-7813
Mailing address
12211 Regency Village Dr
Suite 2
Orlando, FL 32821-7813
Phone (407) 212-3060
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002150900 | Medicaid | FL | |
| 1465P | Other | FL | BCBS |
National Provider Directory
National Provider DirectoryLocations
12211 Regency Village Dr
Ste 2
Orlando, FL 32821
Phone (407) 212-3060
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273104000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1328054400000",
"number": "1730407420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12211 REGENCY VILLAGE DR",
"address_2": "SUITE 2",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328217813",
"telephone_number": "407-212-3060",
"fax_number": "877-644-7808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12211 REGENCY VILLAGE DR",
"address_2": "SUITE 2",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328217813",
"telephone_number": "407-212-3060",
"fax_number": "877-644-7808"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PREMIUM MEDICAL CLINIC PA",
"organizational_subpart": "NO",
"enumeration_date": "2010-05-06",
"last_updated": "2012-02-01",
"status": "A",
"authorized_official_last_name": "ABDEL-AL",
"authorized_official_first_name": "SAFAA",
"authorized_official_title_or_position": "PRESIDENT/OWNER",
"authorized_official_telephone_number": "407-212-3060",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME97108",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002150900",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "1465P",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
- Premise Health of Florida Medical PA (McCoy Federal Credit Union - Orlando)
- Premise Health of Florida Medical PA (HGV Wellness Center)
- Premise Health of Florida Medical PA (The Wellness Center Operated by Premise Health)
- Premise Health of Florida Medical PA (Center for Living Well -South Orlando)
- Premise Health of Florida Medical PA (AT&T Health & Wellbeing Center Operated by Premise Health)
- Princess Marie Prendergast, ARNP
- Shuquia Tinieq Nioami Prentice -Gonsalves, DOULA
- Presbyterian Retirement Communities Inc
- Presbyterian Retirement Communities, Inc. (Westminster Towers)
- A J Prescott, CPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.