NPIMap

Organization Active NPI

SMH Physician Services Inc

Doing business as SMH Geriatrics-Sarasota Memorial Physician Group

  • Geriatric Medicine (Internal Medicine) Physician
  • Sarasota, FL
National Provider Identifier
1902919236
Registry record updated Jan 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
SMH PHYSICIAN SERVICES INC
Doing business as
SMH Geriatrics-Sarasota Memorial Physician Group
Practice address
1921 Waldemere St
Suite 403
Sarasota, FL 34239-2943
Phone
(941) 917-7197
Fax
(941) 917-4016
NPI assigned
Aug 17, 2006
Last updated
Jan 5, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2009

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

Authorized official

Name
Ms. Della K. Shaw
Title
Coo
Phone
(941) 917-8720

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X FL
Geriatric Medicine (Internal Medicine) Physician 207RG0300X FL Primary
Geriatric Psychiatry Physician 2084P0805X FL

Addresses

Primary practice location

1921 Waldemere St
Suite 403
Sarasota, FL 34239-2943

Mailing address

PO Box 863407
Orlando, FL 32886-3407
Phone (941) 917-7197

Other identifiers 1

IdentifierTypeStateIssuer
376537700MedicaidFL

Other names 1

  • SMH Geriatrics-Sarasota Memorial Physician Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031231000211 FL Part B Supplier - Clinic/Group Practice 1355240177 Receives reassigned benefits from 1,046 practitioners
42 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sarasota, FL; Venice, FL; Osprey, FL; Lakewood Ranch, FL; North Port, FL; Bradenton, FL; North Venice, FL

Other NPIs on the same Medicare enrollment 42

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

View all 42

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231113600000",
    "number": "1902919236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 863407",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328863407",
            "telephone_number": "941-917-7197",
            "fax_number": "941-917-4016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 WALDEMERE ST",
            "address_2": "SUITE 403",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342392943",
            "telephone_number": "941-917-7197",
            "fax_number": "941-917-4016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMH PHYSICIAN SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2009-01-05",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "DELLA",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "941-917-8720",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "376537700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMH Geriatrics-Sarasota Memorial Physician Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sarasota, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2009; 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.