Advanced Medical Clinic P a
Organization Active NPI Internal Medicine Physician · Wellington, FL
NPI 1912005182 · NPPES record last updated Jul 2, 2012
Key facts
- NPI
- 1912005182
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- ME81674 (FL)
- Legal business name
- ADVANCED MEDICAL CLINIC P A
- Practice address
- 3347 State RD7
Suite 206
Wellington, FL 33449-8095 - Phone
- (561) 434-1935
- Fax
- (561) 434-3169
- NPI assigned
- Sep 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Ishan A Gunawardene, MD
- Title
- President & Ceo
- Phone
- (561) 434-1935
Other NPIs on the same Medicare enrollment 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051128000225 | FL | Part B Supplier - Clinic/Group Practice | 3274553912 |
Receives reassigned benefits from 4 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wellington, FL; West Palm Beach, FL; Royal Palm Beach, FL; Atlantis, FL |
National Provider Directory
Locations
10101 Forest Hill Blvd
Ste 206
Wellington, FL 33414
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GCCIAA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | ME81674 | FL | Yes |
Addresses
Primary practice location
3347 State RD7
Suite 206
Wellington, FL 33449-8095
Mailing address
3347 State Road 7
Suite 206
Wellington, FL 33449-8095
Phone (561) 434-1935
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33244 | Other | FL | BCBS GROUP |
| DF6667 | Other | FL | RR MEDICARE |
Other providers in Wellington, FL
- Sandra Faye Adams
- Darmaan Osman Aden
- Adolfo Colman MD
- Advanced Breast Care of the Palm Beaches, PA.
- Advanced Endodontics of Wellington
- Advanced Medical Clinic P.a
- Advanced Metropolitan Radiology LLC
- Advanced Psychoeducational Services
- Advent Family Practice, Inc
- Affordable Medical Clinic of Wellii
All providers in Wellington, FL · Internal Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.