Prime Health of North Port LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME84648 Issued in FL

Legal business name

PRIME HEALTH OF NORTH PORT LLC

Practice address

2975 Bobcat Village Center Rd
Suite 100
North Port, FL 34288-4600

Phone

(941) 423-9936

Fax

(941) 426-9794

NPI assigned

Jun 4, 2006

Organization subpart

No

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

Authorized official

Name

Lee Gross, MD

Title

Owner

Phone

(941) 423-9936

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

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

• Candice D Martens Nicoll, ARNP

  • Family Nurse Practitioner
  • North Port, FL
  • NPI 1669798641
  Medicare reassignment NPD

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317081600000",
    "number": "1740228386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 BOBCAT VILLAGE CENTER RD",
            "address_2": "SUITE 100",
            "city": "NORTH PORT",
            "state": "FL",
            "postal_code": "342884600",
            "telephone_number": "941-423-9936",
            "fax_number": "941-426-9794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 BOBCAT VILLAGE CENTER RD",
            "address_2": "SUITE 100",
            "city": "NORTH PORT",
            "state": "FL",
            "postal_code": "342884600",
            "telephone_number": "941-423-9936",
            "fax_number": "941-426-9794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTH OF NORTH PORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2011-09-27",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-423-9936",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME84648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Port Charlotte Hma Physician Management LLC
• Yanexis Portilla
• Ever L Presutti, PTA
• Jeffre Ogilvie Price, DC
• Primary Care Practitioners of Florida
• Heather Proctor, LMHC
• Ann Marie Profetto, APRN
• Progressus Therapy, LLC
• Carline Elizabeth Proux, NA
• Publix Super Markets Inc

• Family Medicine Physician in North Port, FL
• Providers in North Port, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; 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.