NPIMap

Organization Active NPI

Optumcare Florida, LLC

  • Non-Pharmacy Dispensing Site
  • Orlando, FL
National Provider Identifier
1912374943
Registry record updated Aug 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
ME74038 Issued in FL
Legal business name
OPTUMCARE FLORIDA, LLC
Practice address
7240 W Colonial Dr
Orlando, FL 32818-6749
Phone
(407) 296-2273
NPI assigned
Aug 25, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2019

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

Authorized official

Name
John G. Liethen
Title
Secretary
Phone
(952) 205-6262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X ME74038 FL Primary

Addresses

Primary practice location

7240 W Colonial Dr
Orlando, FL 32818-6749

Mailing address

10051 5TH Street N.
St. Petersburg, FL 33702

Other names 2

  • DaVita Medical Group Doing business as
  • JSA Medical Group- West Colonial Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Davita Medical Group13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1440460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566259200000",
    "number": "1912374943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10051 5TH STREET N.",
            "city": "ST. PETERSBURG",
            "state": "FL",
            "postal_code": "33702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7240 W COLONIAL DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328186749",
            "telephone_number": "407-296-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE FLORIDA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-25",
        "last_updated": "2019-08-20",
        "status": "A",
        "authorized_official_last_name": "LIETHEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "952-205-6262"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "ME74038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DaVita Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JSA Medical Group- West Colonial",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JSA Medical Group- West Colonial",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; 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.