NPIMap

Organization Active NPI

Express Care of Belleview, LLC

  • General Practice Physician
  • Leesburg, FL
National Provider Identifier
1831142389
Registry record updated Dec 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
HC6883 Issued in FL
Legal business name
EXPRESS CARE OF BELLEVIEW, LLC
Practice address
2500 Citrus Blvd.
Leesburg, FL 34748-3063
Phone
(352) 728-2828
Fax
(352) 315-3837
NPI assigned
May 18, 2006
Last updated
Dec 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2012

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

Authorized official

Name
Mr. Michael Crimi Jr., P.A.NPI 1265474357
Title
President / Ceo / Owner
Phone
(352) 427-8680

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
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X HC6883 FL Primary
Rural Health Clinic/Center 261QR1300X HCC6883 FL

Addresses

Primary practice location

2500 Citrus Blvd.
Leesburg, FL 34748-3063

Mailing address

10762 SE US Hwy 441
Belleview, FL 34420-3805
Phone (352) 347-5225

Other identifiers 2

IdentifierTypeStateIssuer
660230400MedicaidFL
660070103MedicaidFL

Other names 1

  • Express Care of Belleview, Inc. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060517000017 FL Part A Provider - Rural Health Clinic 6709794332 Practice locations: Leesburg, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831142389. Details of each certification follow.

Rural health clinic certification: CCN 108991

Legal name
EXPRESS CARE OF BELLEVIEW, LLC
Doing business as
EXPRESS CARE OF LEESBURG
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 9, 2006
Last certification
Sep 5, 2019
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
Aug 1, 1996 in FL
Enrollment address
2500 Citrus Blvd
Leesburg, FL 34748-3063

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1052530Express Care of Leesburg2500 Citrus Blvd, Leesburg, FL 34748Certificate of waiverJun 7, 2028

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.61486

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Michael Crimi Individual 5% Or Greater Direct Ownership Interest Aug 1, 1996
Corporate Director Aug 1, 1996
W-2 Managing Employee Aug 1, 1996

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 8

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": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355356800000",
    "number": "1831142389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10762 SE US HWY 441",
            "city": "BELLEVIEW",
            "state": "FL",
            "postal_code": "344203805",
            "telephone_number": "352-347-5225",
            "fax_number": "352-347-1073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 CITRUS BLVD.",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347483063",
            "telephone_number": "352-728-2828",
            "fax_number": "352-315-3837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPRESS CARE OF BELLEVIEW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2012-12-13",
        "status": "A",
        "authorized_official_last_name": "CRIMI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT / CEO / OWNER",
        "authorized_official_telephone_number": "352-427-8680",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "P.A."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "HC6883",
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "HCC6883",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660230400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660070103",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Express Care of Belleview, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Leesburg, FL

Sources for this page

Verify at the official NPI Registry.