Active NPI
Crystal River Hma Physician Management LLC
- Surgery Physician
- Homosassa, FL
National Provider Identifier
1942960786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- CRYSTAL RIVER HMA PHYSICIAN MANAGEMENT LLC
- Doing business as
- Crystal River Hma Physician Management LLC
- Practice address
- 3475 S Suncoast Blvd
Homosassa, FL 34448-2322 - Phone
- (352) 765-2010
- Fax
- (352) 765-2017
- NPI assigned
- Dec 21, 2021
- Last updated
- Mar 14, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jennifer L Jackson
- Title
- Sr Dir Onboarding & Prov Enrollment
- Phone
- (615) 465-3334
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | NU | ||
| Surgery Physician | 208600000X | NU | Primary |
Addresses
Primary practice location
3475 S Suncoast Blvd
Homosassa, FL 34448-2322
Mailing address
PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-7211
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | FL |
Other names 1
- CRYSTAL RIVER HMA PHYSICIAN MANAGEMENT LLC
National Provider Directory
National Provider Directory- Tax ID family
- Crystal River Hma Physician Management LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Surgery Physician
- Crystal River, FL
- NPI 1164188447
-
- Surgery Physician
- Hernando, FL
- NPI 1699441667
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1640044800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1647216000000",
"number": "1942960786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 689022",
"city": "FRANKLIN",
"state": "TN",
"postal_code": "370689022",
"telephone_number": "615-465-7211",
"fax_number": "877-892-9815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3475 S SUNCOAST BLVD",
"city": "HOMOSASSA",
"state": "FL",
"postal_code": "344482322",
"telephone_number": "352-765-2010",
"fax_number": "352-765-2017"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CRYSTAL RIVER HMA PHYSICIAN MANAGEMENT LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-12-21",
"last_updated": "2022-03-14",
"certification_date": "2022-03-14",
"status": "A",
"authorized_official_last_name": "JACKSON",
"authorized_official_first_name": "JENNIFER",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "SR DIR ONBOARDING & PROV ENROLLMENT",
"authorized_official_telephone_number": "615-465-3334"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CRYSTAL RIVER HMA PHYSICIAN MANAGEMENT LLC",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "CRYSTAL RIVER HMA PHYSICIAN MANAGEMENT LLC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Homosassa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.