St Peter Medical Group Inc.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

ST PETER MEDICAL GROUP INC.

Practice address

339 Cypress Pkwy Ste 110
Kissimmee, FL 34759

Phone

(407) 922-0240

Fax

(407) 343-5199

NPI assigned

Jun 23, 2018

Organization subpart

No

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

Authorized official

Name

Miriam L Rivera-Irizarry, MDNPI 1356304828

Title

Ceo

Phone

(407) 729-8173

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Miriam L Rivera Irizarry, M.D.

  • Internal Medicine Physician
  • Kissimmee, FL
  • NPI 1356304828
  Medicare reassignment NPD Authorized official
• Jose Sandalio Rivera Irizarry, M.D.

  • General Practice Physician
  • Pompano Beach, FL
  • NPI 1497742316
  NPD

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

{
    "created_epoch": "1529712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1942795869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 582170",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347580027",
            "telephone_number": "407-922-0240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 CYPRESS PKWY STE 110",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34759",
            "telephone_number": "407-922-0240",
            "fax_number": "407-343-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST PETER MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-23",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "RIVERA-IRIZARRY",
        "authorized_official_first_name": "MIRIAM",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "407-729-8173",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356304828",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kairy Margarita Springer
• Bradley Sprinkle, COTA/L
• Iman Marie Squires, DO
• SSL PT LLC
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• St. Cloud Eye Center Inc
• St. Cloud Eye Center, Inc
• St.Cloud Pharmacy&Wellness Center
• Pamela A St.Victor
• Mary Staffa

• Primary Care Clinic/Center in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.