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Individual provider Active NPI

Rene A Lee Pack, MD

  • Family Medicine Physician
  • Gainesville, FL
National Provider Identifier
1851358766
Registry record updated Jul 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME57143 Issued in FL
Practice address
4410 W Newberry Rd Ste B
Gainesville, FL 32607-2290
Phone
(352) 372-7800
Fax
(352) 372-7879
NPI assigned
Apr 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME57143 FL Primary

Addresses

Primary practice location

4410 W Newberry Rd Ste B
Gainesville, FL 32607-2290

Mailing address

4410 W Newberry Rd
Suite B
Gainesville, FL 32607-5200
Phone (352) 372-7800

Other identifiers 4

IdentifierTypeStateIssuer
218976OtherFLAVMED
11688OtherFLBLUE CROSS BLUE SHIELD
E73090OtherFLVISTA HEALTHPLAN
6467734OtherFLCIGNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101013000922 FL Practitioner - Family Practice 3678535515 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Florida College of Medicine, 1988
Medicare assignment
May accept Medicare assignment
Group practices
Family Practice Associates PAGroup PAC ID 7416919352, 4 clinicians
Lake Area Physical Therapy Inc.Group PAC ID 3678604840, 372 clinicians

Practice addresses (Care Compare)

4410 Newberry Rd
Suite B
Gainesville, FL 32607-2290
Phone (352) 372-7800

PO Box
Suite 1099
Melrose, FL 32666-1099

Hospital & facility affiliations

  • Uf Health Shands Hospital Hospital, Gainesville, FL, CCN 100113
  • HCA Florida North Florida Hospital Hospital, Gainesville, FL, CCN 100204

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice Associates PA Family Medicine CurrentSince Oct 1, 2000 Accepting new patients
Emergency Medical Center, Inc Past Accepting new patients
Atlas Diagnostics Inc PastSince Oct 1, 2000 Accepting new patients

Locations

4410 Newberry Rd
Ste B
Gainesville, FL 32607
Phone (352) 372-7800

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1851358766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 W NEWBERRY RD",
            "address_2": "SUITE B",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326075200",
            "telephone_number": "352-372-7800",
            "fax_number": "352-372-7879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 W NEWBERRY RD STE B",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326072290",
            "telephone_number": "352-372-7800",
            "fax_number": "352-372-7879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE PACK",
        "first_name": "RENE",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME57143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "218976",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "11688",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISTA HEALTHPLAN",
            "identifier": "E73090",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6467734",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.