Peninsula Rehabilitation and Nursing Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PENINSULA REHABILITATION AND NURSING CENTER LLC

Doing business as

Peninsula Rehabilitation and Nursing Center

Practice address

900 Beckett Way
Tarpon Springs, FL 34689-5709

Phone

(727) 934-0876

Fax

(727) 545-8783

NPI assigned

Jul 20, 2022

Organization subpart

No

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

Authorized official

Name

Mathew Varghese

Title

Member

Phone

(917) 817-3530

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Peninsula Rehabilitation and Nursing Center Doing business as

Electronic endpoints 1

Networks

• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

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

{
    "created_epoch": "1658275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1801521141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 BECKETT WAY",
            "city": "TARPON SPRINGS",
            "state": "FL",
            "postal_code": "346895709",
            "telephone_number": "727-934-0876",
            "fax_number": "727-545-8783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 BECKETT WAY",
            "city": "TARPON SPRINGS",
            "state": "FL",
            "postal_code": "346895709",
            "telephone_number": "727-934-0876",
            "fax_number": "727-545-8783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA REHABILITATION AND NURSING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-20",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "VARGHESE",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "917-817-3530"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "1082095",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://peninsulacare.com/",
            "affiliation": "N",
            "address_1": "900 Beckett Way",
            "city": "Tarpon Springs",
            "state": "FL",
            "country_code": "US",
            "postal_code": "346895709",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Peninsula Rehabilitation and Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicolas Pavouris, MD
• Joseph Pawlik, PT
• Taylor Shea Paxton, CAP
• PCM Health Care of Pinellas County Inc
• Peninsula Care and Rehabilitation Center by Harborview LLC
• Pamela Perenich, ARNP
• Keiry Perez
• Sandra Peterson, RN, LMT
• Brian Allister Phillpotts, M.D.
• Julian Thomas Pierce, M.D.

• Skilled Nursing Facility in Tarpon Springs, FL
• Providers in Tarpon Springs, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 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.