NPIMap

The Christian & Missionary Alliance Foundation Inc

Organization Active NPI General Practice Physician · Fort Myers, FL

NPI 1821160607 · NPPES record last updated Feb 14, 2022

Key facts

NPI
1821160607
Entity type
Organization (NPI type 2)
Primary specialty
General Practice Physician 208D00000X
Legal business name
THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC
Practice address
13880 Shell Point Plaza
Suite 110
Fort Myers, FL 33908
Phone
(239) 466-1111
Fax
(239) 454-2111
NPI assigned
Nov 15, 2006
Organization subpart
Yes
Parent organization (as reported)
THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC

Authorized official

Name
Tasha Marie Vassar
Title
Medical Billing Manager
Phone
(239) 433-7937

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 22

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0982512Shell Point Village Medical Center
13880 Shell Point Plaza, Medical Center - Ste 110, Fort Myers, FL 33908		Certificate of waiverJan 28, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in FL

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Shell Point Home Health
Fort Myers, FL · CCN 687083		 Home health agency 5% Or Greater Direct Ownership Interest (100%)
5% Or Greater Mortgage Interest (13.2%)
5% Or Greater Security Interest (14.9%)
Other (100%)		 May 30, 2019
Jul 10, 2019
Sep 9, 2016
Mar 23, 1967

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040207000013 FL Part B Supplier - Clinic/Group Practice 9739072232 Receives reassigned benefits from 22 practitioners
Practice locations: Fort Myers, FL

National Provider Directory

Tax ID family
Loren J Zehr MD (6 organizations share this tax ID)
Part of
Loren J Zehr MD

Locations

13880 Shell Point Plz
#100
Fort Myers, FL 33908

15051 Shell Point Blvd
Fort Myers, FL 33908
Phone (239) 454-2146

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist
Group: 193200000X MULTI-SPECIALTY GROUP		 103TC0700X
Clinical Social Worker
Group: 193200000X MULTI-SPECIALTY GROUP		 1041C0700X
General Practice Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208D00000X Yes
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X

Addresses

Primary practice location

13880 Shell Point Plaza
Suite 110
Fort Myers, FL 33908

Mailing address

13880 Shell Point Plaza
Suite 110
Fort Myers, FL 33908-3504
Phone (239) 454-2146

Other practice location 1

15051 Shell Point Blvd
Fort Myers, FL 33908-1639
Phone (239) 454-2146

Other names

  • Shell Point Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 14, 2022.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644796800000",
    "number": "1821160607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13880 SHELL POINT PLAZA",
            "address_2": "SUITE 110",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339083504",
            "telephone_number": "239-454-2146",
            "fax_number": "239-454-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13880 SHELL POINT PLAZA",
            "address_2": "SUITE 110",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "33908",
            "telephone_number": "239-466-1111",
            "fax_number": "239-454-2111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15051 Shell Point Blvd",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339081639",
            "country_code": "US",
            "telephone_number": "239-454-2146",
            "fax_number": "239-454-2111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC",
        "enumeration_date": "2006-11-15",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-02",
        "status": "A",
        "authorized_official_last_name": "VASSAR",
        "authorized_official_first_name": "TASHA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MEDICAL BILLING MANAGER",
        "authorized_official_telephone_number": "239-433-7937"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shell Point",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shell Point",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Myers, FL

All providers in Fort Myers, FL · General Practice Physician in Florida

Sources for this page

Verify at the official NPI Registry.