NPIMap

Organization Active NPI

Centerwell Senior Primary Care (FL) Inc.

  • Internal Medicine Physician
  • Kissimmee, FL
National Provider Identifier
1922039254
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CENTERWELL SENIOR PRIMARY CARE (FL) INC.
Practice address
904B Cypress Pkwy
Kissimmee, FL 34759-3456
Phone
(407) 483-1400
Fax
(407) 483-1405
NPI assigned
Jul 5, 2006
Organization subpart
Yes
Parent organization
CENTERWELL SENIOR PRIMARY CARE (FL) INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Authorized official

Name
Angie Martinez
Title
Senior Credentialing Professional
Phone
(407) 447-7120

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X FL
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X FL Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

904B Cypress Pkwy
Kissimmee, FL 34759-3456

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000

Other identifiers 1

IdentifierTypeStateIssuer
025017711MedicaidFL

Other names 4

  • CenterWell Senior Primary Care of Poinciana Doing business as
  • FAMILY PHYSICIANS OF WINTER PARK, INC. Former legal business name
  • Family Physicians of Winter Park PA Former legal business name
  • Family Physicians of Poinciana Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040419001657 FL Part B Supplier - Clinic/Group Practice 9830184738 Receives reassigned benefits from 135 practitioners
31 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Altamonte Springs, FL; Winter Park, FL; The Villages, FL; Saint Cloud, FL; Oviedo, FL; Orlando, FL; Longwood, FL; Leesburg, FL…

Other NPIs on the same Medicare enrollment 27

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

View all 27

National Provider Directory

National Provider Directory
Tax ID family
Family Physicians of Winter Park28 organizations share this tax ID, including this one
Part of
Family Physicians of Winter Park

Other organizations with this tax ID 27

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

View all 27

Locations

485 S Ronald Reagan Blvd
Longwood, FL 32750
Phone (407) 834-4849

737 S Semoran Blvd
Orlando, FL 32807
Phone (321) 247-4960

1000 Executive Dr
Ste 7
Oviedo, FL 32765
Phone (407) 365-9000

Practitioners & affiliated clinicians

Practitioners 5

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": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734480000000",
    "number": "1922039254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904B CYPRESS PKWY",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347593456",
            "telephone_number": "407-483-1400",
            "fax_number": "407-483-1405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERWELL SENIOR PRIMARY CARE (FL) INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTERWELL SENIOR PRIMARY CARE (FL) INC.",
        "enumeration_date": "2006-07-05",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING PROFESSIONAL",
        "authorized_official_telephone_number": "407-447-7120"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025017711",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CenterWell Senior Primary Care of Poinciana",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAMILY PHYSICIANS OF WINTER PARK, INC.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Family Physicians of Winter Park PA",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Family Physicians of Poinciana",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; 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.