NPIMap

Organization Active NPI

Sunshine Surgical and Wound Care LLC

  • Surgery Physician
  • Lady Lake, FL
National Provider Identifier
1861978652
Registry record updated Nov 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SUNSHINE SURGICAL AND WOUND CARE LLC
Practice address
630 Griffin Ave
Lady Lake, FL 32159-8101
Phone
(877) 850-8762
Fax
(877) 480-9940
NPI assigned
Jul 14, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2018

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

Authorized official

Name
Robert Marriott, MDNPI 1700804887
Title
Managing Member
Phone
(310) 402-6811

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
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

630 Griffin Ave
Lady Lake, FL 32159-8101

Mailing address

222 N Pacific Coast Hwy Ste 2175
El Segundo, CA 90245-5639
Phone (877) 850-8762

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170710002574 FL Part B Supplier - Clinic/Group Practice 1658640487 Receives reassigned benefits from 10 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Naples, FL; New Port Richey, FL; Ocala, FL; Orange City, FL; Palm Bay, FL; Palm Harbor, FL; Safety Harbor, FL; Saint Cloud, FL…

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Sunshine Surgical and Wound4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

301 NE 141st St
North Miami, FL 33161
Phone (305) 893-1102

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1531526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541635200000",
    "number": "1861978652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 N PACIFIC COAST HWY STE 2175",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902455639",
            "telephone_number": "877-850-8762",
            "fax_number": "877-480-9940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 GRIFFIN AVE",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321598101",
            "telephone_number": "877-850-8762",
            "fax_number": "877-480-9940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNSHINE SURGICAL AND WOUND CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-14",
        "last_updated": "2018-11-08",
        "status": "A",
        "authorized_official_last_name": "MARRIOTT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "310-402-6811",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lady Lake, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; 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.