NPIMap

Organization Active NPI

QSS-Southeast Clinical Services LLC

  • Surgery Physician
  • Orlando, FL
National Provider Identifier
1740521137
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
QSS-SOUTHEAST CLINICAL SERVICES LLC
Practice address
4215 Edgewater Dr
Orlando, FL 32804-2206
Phone
(407) 539-2000
Fax
(407) 398-0050
NPI assigned
Mar 8, 2013
Last updated
Jul 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Authorized official

Name
Careen E Wilson
Title
Manager
Phone
(973) 894-1263

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X FL Primary

Addresses

Primary practice location

4215 Edgewater Dr
Orlando, FL 32804-2206

Mailing address

PO Box 4095
Wayne, NJ 07470-4095
Phone (973) 826-8080

Other identifiers 5

IdentifierTypeStateIssuer
004AHOtherFLBLUE CROSS BLUE SHIELD OF FL
113496900MedicaidFL
1740521137OtherFLCIGNA
3593907OtherFLUHC
DU0724OtherFLRR MEDICARE

National Provider Directory

National Provider Directory

Locations

4215 Edgewater Dr
Orlando, FL 32804
Phone (407) 539-2000

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1362700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688688000000",
    "number": "1740521137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4095",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074704095",
            "telephone_number": "973-826-8080",
            "fax_number": "866-309-3354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4215 EDGEWATER DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328042206",
            "telephone_number": "407-539-2000",
            "fax_number": "407-398-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QSS-SOUTHEAST CLINICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-08",
        "last_updated": "2023-07-07",
        "certification_date": "2023-06-30",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CAREEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "973-894-1263"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF FL",
            "identifier": "004AH",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113496900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1740521137",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "3593907",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DU0724",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.