NPIMap

Organization Active NPI

South Lake Internal Medicine PA

  • Adult Medicine Physician
  • Clermont, FL
National Provider Identifier
1801838313
Registry record updated Sep 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
SOUTH LAKE INTERNAL MEDICINE PA
Practice address
1371 Citrus Tower Blvd
Clermont, FL 34711-1924
Phone
(352) 243-2141
Fax
(352) 243-1309
NPI assigned
Jun 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2008

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

Authorized official

Name
Dr. James M Ray
Title
President
Phone
(352) 394-1969

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QA0505X Primary

Addresses

Primary practice location

1371 Citrus Tower Blvd
Clermont, FL 34711-1924

Mailing address

1101 Citrus Tower Blvd
Clermont, FL 34711-1905
Phone (352) 243-2141

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221696000000",
    "number": "1801838313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 CITRUS TOWER BLVD",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111905",
            "telephone_number": "352-243-2141",
            "fax_number": "352-243-1309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1371 CITRUS TOWER BLVD",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111924",
            "telephone_number": "352-243-2141",
            "fax_number": "352-243-1309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LAKE INTERNAL MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2008-09-18",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-394-1969",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2008; 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.