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1503 Bill Beck Blvd Kissimmee FL 34744-9516 | |
| (407) 943-8600 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1503 Bill Beck Blvd, Kissimmee, Florida |
| Authorized Official Name and Position | Belinda Johnson-cornett (CEO) |
| Authorized Official Contact | 4079438670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1503 Bill Beck Blvd Kissimmee FL 34744-9516 Ph: (407) 943-8600 | 1503 Bill Beck Blvd Kissimmee FL 34744-9516 Ph: (407) 943-8600 |
| NPI Number | 1376093609 |
|---|---|
| Provider Enumeration Date | 10/11/2016 |
| Last Update Date | 08/05/2024 |
| Medicare PECOS PAC ID | 4486923059 |
|---|---|
| Medicare Enrollment ID | O20181005000584 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376093609 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Peter J Casella |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1245200278 PECOS PAC ID: 2567411564 Enrollment ID: I20050118000031 |
| Provider Name | John K Fusselman |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1083711196 PECOS PAC ID: 4385693894 Enrollment ID: I20050121000266 |
| Provider Name | Marthilde Lambert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992069314 PECOS PAC ID: 7214182203 Enrollment ID: I20130222000439 |
| Provider Name | Anna Harris |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1487849600 PECOS PAC ID: 5092953265 Enrollment ID: I20130529000614 |
| Provider Name | Jose Alfredo Alvarez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497014765 PECOS PAC ID: 7113249749 Enrollment ID: I20150121001649 |
| Provider Name | Jasmine Natasha Raymond |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1891060414 PECOS PAC ID: 6901118207 Enrollment ID: I20150629002480 |
| Provider Name | Garry Beaubrun Antoine |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1689073819 PECOS PAC ID: 8820301641 Enrollment ID: I20150722004092 |
| Provider Name | Beatrice Aime Celian |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1285031948 PECOS PAC ID: 8022397512 Enrollment ID: I20161128002664 |
| Provider Name | Teresita Ryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215392154 PECOS PAC ID: 7416201157 Enrollment ID: I20181114003607 |
| Provider Name | Alex Andujar Alejandro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679760680 PECOS PAC ID: 8628247301 Enrollment ID: I20190125001968 |
| Provider Name | Yordanska Brito Torres |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487946422 PECOS PAC ID: 1153652565 Enrollment ID: I20191016003004 |
| Provider Name | Vicky Arlene Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336798412 PECOS PAC ID: 8325474455 Enrollment ID: I20200207000912 |
| Provider Name | Daisy Ivellisse Velez Velez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1316999378 PECOS PAC ID: 8729091905 Enrollment ID: I20200805001438 |
| Provider Name | Muhammad Asad Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821380544 PECOS PAC ID: 1355619172 Enrollment ID: I20210614000259 |
| Provider Name | Melissa Santiago |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952955734 PECOS PAC ID: 2769848753 Enrollment ID: I20230517002010 |
| Provider Name | Luciol Danjoint Livette |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1023409984 PECOS PAC ID: 0345550539 Enrollment ID: I20240509002532 |
| Provider Name | Alexis Brianna Abernathy |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1619653607 PECOS PAC ID: 7911443353 Enrollment ID: I20240723000074 |
| Provider Name | Carmen Arrufat Ives |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104565563 PECOS PAC ID: 5799225140 Enrollment ID: I20240911004226 |
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