Family Health Center at Port St John LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS9694 Issued in FL

Legal business name

FAMILY HEALTH CENTER AT PORT ST JOHN LLC

Practice address

3740 Curtis Blvd
Suite 108
Cocoa, FL 32927-3962

Phone

(321) 633-5500

Fax

(321) 633-5566

NPI assigned

Dec 19, 2007

Last updated

Dec 3, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Janis G Black, D.O.NPI 1699721548

Title

Physician/Owner

Phone

(321) 633-5500

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EIDJAA

Practitioners 5

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.

• Janis G Black, DO

  • Family Medicine Physician
  • Cocoa, FL
  • NPI 1699721548
  Medicare reassignment Care Compare group NPD Authorized official
• Taniqua Denise Andrews, NP-C

  • Family Nurse Practitioner
  • Port St John, FL
  • NPI 1548862998
  Medicare reassignment Care Compare group NPD
• Olga Dorjima Emgushov, MD,MPH

  • Hospitalist Physician
  • Melbourne, FL
  • NPI 1003841222
  Medicare reassignment NPD
• Haleigh Lillian Andreasen, FNP

  • Nurse Practitioner
  • Port Saint John, FL
  • NPI 1427754290
  NPD
• Sarah Maria Sampson Crandall, FNP

  • Primary Care Nurse Practitioner
  • Port St John, FL
  • NPI 1851102305
  NPD

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386028800000",
    "number": "1851575377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3740 CURTIS BLVD",
            "address_2": "SUITE 108",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329273962",
            "telephone_number": "321-633-5500",
            "fax_number": "321-633-5566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3740 CURTIS BLVD",
            "address_2": "SUITE 108",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329273962",
            "telephone_number": "321-633-5500",
            "fax_number": "321-633-5566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTER AT PORT ST JOHN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-19",
        "last_updated": "2013-12-03",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "JANIS",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "321-633-5500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS9694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2753011400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margrit Estrada
• Crystal Etienne
• Exquisite Hair & Replacement LLC
• Family Counseling Center of Brevard Inc
• Family First Staffing Agency
• Family Medical Care of Brevard P.a. (Brevard Medical Group)
• Family Preservation Services
• Christine Marie Fargo, ARNP
• Ashley Ferrell
• Zoe Fiandaca

• Family Medicine Physician in Cocoa, FL
• Providers in Cocoa, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.