NPIMap

Organization Active NPI

Family Health Centers of Southwest Florida, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bonita Springs, FL
National Provider Identifier
1891005047
Registry record updated Jun 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Practice address
11921 Saradrienne LN
Bonita Springs, FL 34135-5911
Phone
(239) 344-2331
Fax
(239) 949-1593
NPI assigned
Oct 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2022

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

Authorized official

Name
Frank Mazzeo Jr., D.D.S.
Title
President/ Ceo
Phone
(239) 278-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

11921 Saradrienne LN
Bonita Springs, FL 34135-5911

Mailing address

PO Box 919771
Orlando, FL 32891-9771
Phone (239) 278-3600

Other identifiers 3

IdentifierTypeStateIssuer
029570106MedicaidFL
99409OtherBLUE CROSS BLUE SHIELD
056887205MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040106000084 FL Part B Supplier - Clinic/Group Practice 3173432085 Receives reassigned benefits from 36 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Port Charlotte, FL; Lehigh Acres, FL; Labelle, FL; Fort Myers, FL; Bonita Springs, FL; Cape Coral, FL
O20140722002462 FL Part A Provider - Federally Qualified Health Center (FQHC) 3173432085 Practice locations: Bonita Springs, FL

Federally qualified health center certification: CCN 101163

Legal name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 22, 2014
Last certification
Jun 22, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 13, 1977 in FL
Enrollment address
11921 Saradrienne LN
Bonita Springs, FL 34135-5911

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

11921 Saradrienne Ln
Unit 2
Bonita Springs, FL 34135

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Catherine Palmisano Individual Corporate Director Jan 1, 2020
Leah McCann Individual Corporate Director May 1, 2013
Patricia Epifanio Individual Corporate Director Nov 1, 2017
Lolita Winifred Melhado Individual Corporate Director Dec 1, 2020
Beth Hendry Individual Corporate Director Sep 1, 2018
Jorge M Quinonez Individual Corporate OfficerExecutive VP/ Cmo Jul 5, 2005
W-2 Managing EmployeeExecutive VP/ Cmo Jul 5, 2005
Theresa Buchanan Individual Corporate OfficerExecutive Vice President/ Cao Oct 19, 2009
W-2 Managing EmployeeExecutive Vice President/ Cao Oct 19, 2009
Tomy Laufer Individual Corporate Director Aug 1, 2016
Frank Mazzeo Individual Corporate OfficerPresident/ Ceo Jun 15, 1999
W-2 Managing EmployeePresident/ Ceo Jun 15, 1999

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 3

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": "1287532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655769600000",
    "number": "1891005047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 919771",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328919771",
            "telephone_number": "239-278-3600",
            "fax_number": "239-226-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11921 SARADRIENNE LN",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341355911",
            "telephone_number": "239-344-2331",
            "fax_number": "239-949-1593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-20",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A",
        "authorized_official_last_name": "MAZZEO",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "PRESIDENT/ CEO",
        "authorized_official_telephone_number": "239-278-3600",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029570106",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "99409",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "056887205",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonita Springs, FL

Sources for this page

Verify at the official NPI Registry.