NPIMap

Organization Active NPI

Family Health Centers of Southwest Florida, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fort Myers, FL
National Provider Identifier
1821412016
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Practice address
19701 S Tamiami TRL
Fort Myers, FL 33908-4818
Phone
(239) 314-1600
Fax
(239) 425-6402
NPI assigned
Feb 10, 2014
Last updated
May 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Authorized official

Name
Frank Mazzeo Jr., DDSNPI 1962597047
Title
President/ Ceo
Phone
(239) 278-3600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Clinic Pharmacy 3336C0002X PH28479 FL

Addresses

Primary practice location

19701 S Tamiami TRL
Fort Myers, FL 33908-4818

Mailing address

PO Box 919771
Orlando, FL 32891-9771
Phone (239) 278-3600

Other identifiers 2

IdentifierTypeStateIssuer
029570124MedicaidFL
029570117MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140722002084 FL Part A Provider - Federally Qualified Health Center (FQHC) 3173432085 Practice locations: Fort Myers, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821412016. Details of each certification follow.

Federally qualified health center certification: CCN 101178

Legal name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 22, 2014
Last certification
Jul 22, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 13, 1977 in FL
Enrollment address
19701 S Tamiami TRL
Fort Myers, FL 33908-4818

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory

Locations

19701 S Tamiami Trl
Fort Myers, FL 33908
Phone (239) 314-1600

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 Máximo (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)

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Grace Alexander-Cortez Individual Corporate Director Mar 1, 2019
Catherine Palmisano Individual Corporate Director Jan 1, 2020
Leah McCann Individual Corporate Director May 1, 2013
Patricia Epifanio Individual Corporate Director Nov 1, 2017
Lolita Winifred Melhado Individual Corporate Director Dec 1, 2020
Jay McGregor Individual Corporate Director Jun 1, 2015
Beth Hendry Individual Corporate Director Sep 1, 2018
Jorge M Quinonez Individual Corporate OfficerExecutive Vice President/ Cmo Jul 5, 2005
W-2 Managing EmployeeExecutive Vice President/ Cmo Jan 15, 2006
Estela Aguilar Individual Corporate Director Mar 1, 2019
Theresa Buchanan Individual Corporate OfficerExecutive Vice President/ Cao Oct 19, 2009
W-2 Managing EmployeeExecutive Vice President/ Cao Oct 19, 2009
Jose Fernandez Individual Corporate Director Mar 1, 2016
Tomy Laufer Individual Corporate Director Aug 1, 2016
Frank Mazzeo Individual Corporate OfficerPresident/ Ceo Jun 15, 1999
W-2 Managing EmployeePresident/ Ceo Jun 15, 1999

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

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": "1391990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652832000000",
    "number": "1821412016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 919771",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328919771",
            "telephone_number": "239-278-3600",
            "fax_number": "239-226-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19701 S TAMIAMI TRL",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339084818",
            "telephone_number": "239-314-1600",
            "fax_number": "239-425-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-10",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A",
        "authorized_official_last_name": "MAZZEO",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "PRESIDENT/ CEO",
        "authorized_official_telephone_number": "239-278-3600",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "FL",
            "license": "PH28479",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029570124",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029570117",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.