NPIMap

Organization Active NPI

Primary Care Medical Services of Poinciana Inc

  • Federally Qualified Health Center (FQHC)
  • Kissimmee, FL
National Provider Identifier
1982002945
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY CARE MEDICAL SERVICES OF POINCIANA INC
Practice address
1501-1507 Bill Beck Blvd
Kissimmee, FL 34744
Phone
(407) 943-8600
NPI assigned
Dec 8, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Authorized official

Name
Mrs. Belinda Johnson-Cornett
Title
Ceo
Phone
(407) 943-8600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1501-1507 Bill Beck Blvd
Kissimmee, FL 34744

Mailing address

1503 Bill Beck Blvd
Kissimmee, FL 34744-9516
Phone (407) 943-8600

Other identifiers 1

IdentifierTypeStateIssuer
000835600MedicaidFL

Other names 1

  • Osceola Community Health Services at Stadium Place Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170713003739 FL Part A Provider - Federally Qualified Health Center (FQHC) 4486923059 Practice locations: Kissimmee, FL

Federally qualified health center certification: CCN 681103

Legal name
PRIMARY CARE MEDICAL SERVICES OF POINCIANA INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 14, 2017
Last certification
Jul 14, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 2017 in FL
Enrollment address
1501-1507 Bill Beck Blvd
Ochs Stadium Place
Kissimmee, FL 34744-9516

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Primary Care Medical Services of Poinciana Inc13 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.

Locations

4303 Cameron Preserve Cir
Kissimmee, FL 34746

1501 Bill Beck Blvd
#1507
Kissimmee, FL 34744

1503 Bill Beck Blvd
Ste 1507
Kissimmee, FL 34744

201 Hilda St
Ste 205
Kissimmee, FL 34741

1505 Bill Beck Blvd
Kissimmee, FL 34744
Phone (407) 343-2036

1501 Bill Beck Blvd
Ste 1505
Kissimmee, FL 34744

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Cynthia Diaz Individual Corporate OfficerCfo Feb 1, 2020
W-2 Managing Employee Sep 6, 2017
Magaly Guzman Individual W-2 Managing EmployeeAdministrative Assistant Apr 1, 2017 5%
Sally Sera Individual Corporate DirectorBoard Member Apr 1, 2017
Belinda Johnson Cornett Individual Corporate OfficerCeo Apr 1, 2017
W-2 Managing EmployeeChief Executive Officer Apr 1, 2017 5%

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Osceola Community Health Services in BVLKissimmee, FL, CCN 681125 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2017
Osceola Community Health Services at Cameron PreserveKissimmee, FL, CCN 101018 Federally qualified health center Operational/Managerial Control Sep 30, 2019

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1417996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1982002945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 BILL BECK BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347449516",
            "telephone_number": "407-943-8600",
            "fax_number": "407-932-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501-1507 BILL BECK BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34744",
            "telephone_number": "407-943-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE MEDICAL SERVICES OF POINCIANA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-08",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-CORNETT",
        "authorized_official_first_name": "BELINDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "407-943-8600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000835600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Osceola Community Health Services at Stadium Place",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Osceola Community Health Services at Stadium Place",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.