| Premier Choice Medical Group Llc | |
|
4851 Nw 103rd Ave Ste 55g Sunrise FL 33351-7948 | |
| (954) 251-4988 | |
| Not Available |
| Full Name | Premier Choice Medical Group Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4851 Nw 103rd Ave Ste 55g, Sunrise, Florida |
| Authorized Official Name and Position | Adam Stanson (OWNER) |
| Authorized Official Contact | 9542514988 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Choice Medical Group Llc Po Box 670251 Coral Springs FL 33067-0005 Ph: (954) 251-4988 | Premier Choice Medical Group Llc 4851 Nw 103rd Ave Ste 55g Sunrise FL 33351-7948 Ph: (954) 251-4988 |
| NPI Number | 1821865361 |
|---|---|
| Provider Enumeration Date | 12/05/2023 |
| Last Update Date | 06/25/2024 |
| Certification Date | 06/25/2024 |
| Medicare PECOS PAC ID | 5395195713 |
|---|---|
| Medicare Enrollment ID | O20231228000312 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821865361 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ellen F Price |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235139650 PECOS PAC ID: 2961563051 Enrollment ID: I20081208000541 |
| Provider Name | Debra Dean |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932118841 PECOS PAC ID: 2668370586 Enrollment ID: I20160630000887 |
| Provider Name | Katrina Forman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447538269 PECOS PAC ID: 1658785233 Enrollment ID: I20210121001896 |
| Provider Name | Kamla D Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861884892 PECOS PAC ID: 3072995034 Enrollment ID: I20220808001532 |
| Provider Name | Steven G Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023267382 PECOS PAC ID: 4981646171 Enrollment ID: I20230421000949 |
| Provider Name | Tristan Freedman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417738576 PECOS PAC ID: 7416304514 Enrollment ID: I20231110002841 |
| Provider Name | Vikke Rochell Brooks |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1588076251 PECOS PAC ID: 3274983291 Enrollment ID: I20240103000327 |
| Provider Name | Paige Leigh Knorr |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1922351196 PECOS PAC ID: 5597101279 Enrollment ID: I20240316000188 |
| Provider Name | Linda Santiago |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174021257 PECOS PAC ID: 0446513147 Enrollment ID: I20240318003659 |
| Provider Name | Rennee Petria Calame |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588923536 PECOS PAC ID: 5092152801 Enrollment ID: I20240327004146 |
| Provider Name | Rebecca June Potter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588848287 PECOS PAC ID: 6608218169 Enrollment ID: I20240529002861 |
| Provider Name | Shoaleh Djebelli |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659018059 PECOS PAC ID: 7810439221 Enrollment ID: I20240612002749 |
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