Active NPI
Heart 2 Heart Family Practice
- Rural Health Clinic/Center
- Melrose, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- HEART 2 HEART FAMILY PRACTICE
- Practice address
- 1326 State Road 100
Melrose, FL 32666-3701 - Phone
- (386) 659-2104
- NPI assigned
- Jun 8, 2020
- Last updated
- Dec 6, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dollicia Green, APRN
- Title
- President
- Phone
- (386) 916-0313
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | NU | Primary |
Addresses
Primary practice location
1326 State Road 100
Melrose, FL 32666-3701
Mailing address
1326 State Road 100
Melrose, FL 32666-3701
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110545600 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200810003603 | FL | Part A Provider - Rural Health Clinic | 3476978214 | Practice locations: Melrose, FL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1871118604. Details of each certification follow.
Rural health clinic certification: CCN 108922
- Legal name
- HEART 2 HEART FAMILY PRACTICE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 31, 2000
- Last certification
- Apr 17, 2025
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Incorporated
- May 5, 2020 in FL
- Enrollment address
- 1326 State Road 100
Melrose, FL 32666-3701
National Provider Directory
National Provider Directory- Tax ID family
- Heart 2 Heart Family Practice
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- General Practice Physician
- Melrose, FL
- NPI 1386313674
Locations
1326 State Road 100
Melrose, FL 32666
Phone (386) 659-2104
Ownership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Pamela Suzanne Callan | Corporate Director | May 5, 2020 | 40% |
| Dollicia M Green | 5% Or Greater Direct Ownership Interest | May 5, 2020 | 60% |
| W-2 Managing Employee | Sep 15, 2020 | 100% |
Owners & managing parties with NPI records 2
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Nurse Practitioner
- Melrose, FL
- NPI 1891149324
5% Or Greater Direct Ownership Interest, W-2 Managing Employee
Change-of-ownership history 1
| Date | Event | Counterparty |
|---|---|---|
| Sep 15, 2020 | Change of Ownership | Birth & Beyond P.a. |
Change of ownership 1
Medicare changes of ownership in which this facility was the buyer or the seller.
Practitioners & affiliated clinicians
Practitioners 3
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.
-
- Family Nurse Practitioner
- Gainesville, FL
- NPI 1831977206
-
- Family Medicine Physician
- Melrose, FL
- NPI 1598285587
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591574400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1670284800000",
"number": "1871118604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1326 STATE ROAD 100",
"city": "MELROSE",
"state": "FL",
"postal_code": "326663701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1326 STATE ROAD 100",
"city": "MELROSE",
"state": "FL",
"postal_code": "326663701",
"telephone_number": "386-659-2104"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HEART 2 HEART FAMILY PRACTICE",
"organizational_subpart": "NO",
"enumeration_date": "2020-06-08",
"last_updated": "2022-12-06",
"certification_date": "2022-12-06",
"status": "A",
"authorized_official_last_name": "GREEN",
"authorized_official_first_name": "DOLLICIA",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "386-916-0313",
"authorized_official_credential": "APRN"
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110545600",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Melrose, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.