Ridge Manor Family Clinic Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ME0070951 Issued in FL

Legal business name

RIDGE MANOR FAMILY CLINIC INC

Practice address

12204 Cortez Blvd
Brooksville, FL 34613-2630

Phone

(352) 799-3449

Fax

(352) 799-3214

NPI assigned

Jan 7, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Gopal R Korupolu, M.D.NPI 1861437428

Title

Physician/Owner

Phone

(352) 799-3449

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

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

• Gopal R Korupolu, M.D.

  • General Practice Physician
  • Brooksville, FL
  • NPI 1861437428
  Medicare reassignment NPD Authorized official
• Rishank Reddy Korupolu, D.D.S.

  • Dentist
  • Longview, TX
  • NPI 1295177012
  NPD (past)

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

{
    "created_epoch": "1420588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423526400000",
    "number": "1730577115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15781",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346040124",
            "telephone_number": "352-799-3449",
            "fax_number": "352-799-3214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12204 CORTEZ BLVD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346132630",
            "telephone_number": "352-799-3449",
            "fax_number": "352-799-3214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGE MANOR FAMILY CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-07",
        "last_updated": "2015-02-10",
        "status": "A",
        "authorized_official_last_name": "KORUPOLU",
        "authorized_official_first_name": "GOPAL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "352-799-3449",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME0070951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lexi Elizabeth Rice, PTA
• Pauline Rice
• Mackenzie Rose Rich, APRN
• Richard W Springstead MD PA
• Dory Richards, LMFT
• Ridge Manor Family Medicine,LLC
• Leigh A Rignola, RBT
• Seth Brent Riker
• Anali J Rincon, MD
• Jenna Risher

• General Practice Physician in Brooksville, FL
• Providers in Brooksville, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.