NPIMap

Organization Active NPI

Premise Health of Florida Medical, P.a.

Doing business as Liberty Medical

  • Urgent Care Clinic/Center
  • Port Saint Lucie, FL
National Provider Identifier
1780951509
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
PREMISE HEALTH OF FLORIDA MEDICAL, P.A.
Doing business as
Liberty Medical
Practice address
10400 S US Highway 1
Port Saint Lucie, FL 34952-5600
Phone
(772) 398-5651
Fax
(772) 337-4971
NPI assigned
Nov 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Authorized official

Name
Jon Leizman, M.D.
Title
President
Phone
(216) 479-9063

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary
Occupational Medicine Clinic/Center 261QX0100X

Addresses

Primary practice location

10400 S US Highway 1
Port Saint Lucie, FL 34952-5600

Mailing address

5500 Maryland Way
Brentwood, TN 37027-7048

Other names 1

  • Liberty Medical Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premise Health of Florida Medical PA58 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

10400 S US Highway 1
Port St Lucie, FL 34952
Phone (772) 398-5651

NPI Registry JSON

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

{
    "created_epoch": "1321920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1780951509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 S US HIGHWAY 1",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349525600",
            "telephone_number": "772-398-5651",
            "fax_number": "772-337-4971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF FLORIDA MEDICAL, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-22",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Liberty Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Saint Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; 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.