NPIMap

Organization Active NPI

Southeastern Integrated Medical PL

  • Diagnostic Radiology Physician
  • Ocala, FL
National Provider Identifier
1912146853
Registry record updated Feb 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SOUTHEASTERN INTEGRATED MEDICAL PL
Practice address
3304 SW 34TH Cir
Ocala, FL 34474-3358
Phone
(352) 732-4438
Fax
(352) 291-0231
NPI assigned
Feb 17, 2009
Organization subpart
Yes
Parent organization
SOUTHEASTERN INTEGRATED MEDICAL PLAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 17, 2009

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

Authorized official

Name
Mr. Jesse C Brannen
Title
Chief Operating Officer
Phone
(352) 224-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X FL Primary

Addresses

Primary practice location

3304 SW 34TH Cir
Ocala, FL 34474-3358

Mailing address

4881 NW 8TH Avenue
Ste 2
Gainesville, FL 32605-4582
Phone (352) 373-6338

Other identifiers 1

IdentifierTypeStateIssuer
058586600MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Southeastern Integrated Medical PL5 organizations share this tax ID, including this one
Part of
Southeastern Integrated Medical PL

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1234828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234828800000",
    "number": "1912146853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4881 NW 8TH AVENUE",
            "address_2": "STE 2",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054582",
            "telephone_number": "352-373-6338",
            "fax_number": "352-373-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3304 SW 34TH CIR",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344743358",
            "telephone_number": "352-732-4438",
            "fax_number": "352-291-0231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN INTEGRATED MEDICAL PL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEASTERN INTEGRATED MEDICAL PL",
        "enumeration_date": "2009-02-17",
        "last_updated": "2009-02-17",
        "status": "A",
        "authorized_official_last_name": "BRANNEN",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "352-224-2200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058586600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocala, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.