NPIMap

Organization Active NPI

Gulfview Medical Institute PLLC

  • Family Medicine Physician
  • Port Charlotte, FL
National Provider Identifier
1851680789
Registry record updated Jun 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME 106244 Issued in FL
Legal business name
GULFVIEW MEDICAL INSTITUTE PLLC
Practice address
21942 Edgewater Dr
Port Charlotte, FL 33952-9723
Phone
(941) 505-2100
Fax
(941) 505-6100
NPI assigned
Mar 31, 2011
Last updated
Jun 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2020

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

Authorized official

Name
Joseph Ravid, MDNPI 1548466519
Title
Owner
Phone
(941) 505-2100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME 106244 FL Primary

Addresses

Primary practice location

21942 Edgewater Dr
Port Charlotte, FL 33952-9723

Mailing address

21942 Edgewater Dr Ste 1211
Port Charlotte, FL 33952-9723
Phone (941) 505-2100

Other identifiers 3

IdentifierTypeStateIssuer
003XXOtherFLBC/BS
FB001AOtherFLMEDICARE
DS5131OtherFLRAIL ROAD MEDICARE

Other names 1

  • Premier Medical Institute PL Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110627000398 FL Part B Supplier - Clinic/Group Practice 9335327139 Receives reassigned benefits from 11 practitioners
Practice locations: Port Charlotte, FL

National Provider Directory

National Provider Directory

Locations

21942 Edgewater Dr
Ste 1211
Port Charlotte, FL 33952

21942 Edgewater Dr
Pt Charlotte, FL 33952
Phone (941) 505-2100

Practitioners & affiliated clinicians

Practitioners 12

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": "1301529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593475200000",
    "number": "1851680789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21942 EDGEWATER DR STE 1211",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339529723",
            "telephone_number": "941-505-2100",
            "fax_number": "941-505-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21942 EDGEWATER DR",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339529723",
            "telephone_number": "941-505-2100",
            "fax_number": "941-505-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULFVIEW MEDICAL INSTITUTE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-31",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A",
        "authorized_official_last_name": "RAVID",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-505-2100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME 106244",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "003XX",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "FB001A",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "DS5131",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Medical Institute PL",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Premier Medical Institute PL",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.