| Premier Community Healthcare Group Inc | |
|
14027 5th St Dade City FL 33525-4302 | |
| (352) 518-2000 | |
| (352) 567-0218 |
| Full Name | Premier Community Healthcare Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 14027 5th St, Dade City, Florida |
| Authorized Official Name and Position | Jennifer Maffett (HEALTH DATA ANALYST) |
| Authorized Official Contact | 3525182000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Community Healthcare Group Inc Po Box 232 Dade City FL 33526-0232 Ph: (352) 518-2000 | Premier Community Healthcare Group Inc 14027 5th St Dade City FL 33525-4302 Ph: (352) 518-2000 |
| NPI Number | 1841263399 |
|---|---|
| Provider Enumeration Date | 02/07/2006 |
| Last Update Date | 10/09/2019 |
| Medicare PECOS PAC ID | 3476450818 |
|---|---|
| Medicare Enrollment ID | O20031215000701 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841263399 | NPI | - | NPPES |
| 029550700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Donna E Connors |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1902894371 PECOS PAC ID: 5294625125 Enrollment ID: I20040316000911 |
| Provider Name | Ashit K Vijapura |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053367847 PECOS PAC ID: 2163418252 Enrollment ID: I20040423000317 |
| Provider Name | Viva Casler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477544351 PECOS PAC ID: 7618941519 Enrollment ID: I20040825001160 |
| Provider Name | Lailatullah Burgos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285785428 PECOS PAC ID: 3274565692 Enrollment ID: I20050907000506 |
| Provider Name | Jennifer L Harper |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1235188749 PECOS PAC ID: 6204828213 Enrollment ID: I20070420000467 |
| Provider Name | Jeffrey P Jordan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023125556 PECOS PAC ID: 9436167178 Enrollment ID: I20120105000662 |
| Provider Name | Wilma A Dasouza |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497829105 PECOS PAC ID: 5294763249 Enrollment ID: I20121009000092 |
| Provider Name | Lindsay A Curtis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639405475 PECOS PAC ID: 8123270907 Enrollment ID: I20121129000473 |
| Provider Name | Michelle Villar-diaz |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1861644544 PECOS PAC ID: 8123271780 Enrollment ID: I20140812002047 |
| Provider Name | Thomas R Stross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811391063 PECOS PAC ID: 3173745635 Enrollment ID: I20141118000516 |
| Provider Name | Joseph Walter King |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1255392890 PECOS PAC ID: 3678543444 Enrollment ID: I20141217002727 |
| Provider Name | Louann Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710940333 PECOS PAC ID: 5092038943 Enrollment ID: I20141229000536 |
| Provider Name | Reda Awad |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1568768166 PECOS PAC ID: 4385968288 Enrollment ID: I20150126000624 |
| Provider Name | Delrose Brown |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1477526911 PECOS PAC ID: 3577887280 Enrollment ID: I20150128000710 |
| Provider Name | Wendy Masterman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891006888 PECOS PAC ID: 8921325473 Enrollment ID: I20150323001571 |
| Provider Name | Keddie L Marsh Dinham |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1326137340 PECOS PAC ID: 4981792736 Enrollment ID: I20150422000796 |
| Provider Name | Kamlesh N Bajpai |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518018878 PECOS PAC ID: 7911911268 Enrollment ID: I20150818004798 |
| Provider Name | Delisa Heron |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578880480 PECOS PAC ID: 5294850996 Enrollment ID: I20150827002750 |
| Provider Name | Jennifer Pardee Vinalon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033593322 PECOS PAC ID: 1153626866 Enrollment ID: I20160321001863 |
| Provider Name | Christopher Backsman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033589445 PECOS PAC ID: 3577860659 Enrollment ID: I20160405001447 |
| Provider Name | Nicole A Mula |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1376886341 PECOS PAC ID: 9436448156 Enrollment ID: I20160519001952 |
| Provider Name | Eisel Montero Montes De Oca |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477900983 PECOS PAC ID: 6002107893 Enrollment ID: I20160627000599 |
| Provider Name | Yordenys Collazo Eijo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164880308 PECOS PAC ID: 6608169529 Enrollment ID: I20160728002660 |
| Provider Name | Rhonda Cameron |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134191216 PECOS PAC ID: 4082909288 Enrollment ID: I20160826002368 |
| Provider Name | Farhan Rehman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750722708 PECOS PAC ID: 8426350034 Enrollment ID: I20161011001281 |
| Provider Name | John Petrilli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609213016 PECOS PAC ID: 1759668536 Enrollment ID: I20170503002759 |
| Provider Name | Erin Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811364391 PECOS PAC ID: 9234398033 Enrollment ID: I20170711002754 |
| Provider Name | Kjersti L Schwartz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346659992 PECOS PAC ID: 2668795170 Enrollment ID: I20170927002404 |
| Provider Name | Tintu Thykuttathil Mathew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912541582 PECOS PAC ID: 2466885009 Enrollment ID: I20191212000099 |
| Provider Name | Nwando Vivian Okaro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508482662 PECOS PAC ID: 1456778588 Enrollment ID: I20200903000387 |
| Provider Name | Cynthia Np Chiaku |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255963070 PECOS PAC ID: 6305266305 Enrollment ID: I20201013001819 |
| Provider Name | Sharon Resto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861005464 PECOS PAC ID: 3476966359 Enrollment ID: I20210211000068 |
| Provider Name | Elizabeth Oluseun Kolawole |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194222455 PECOS PAC ID: 0143579623 Enrollment ID: I20210616000761 |
| Provider Name | Lisa Ann Lowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972163954 PECOS PAC ID: 0749677383 Enrollment ID: I20220428001511 |
| Provider Name | Cynthia D. Wirkus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023389939 PECOS PAC ID: 9739569609 Enrollment ID: I20220708003286 |
| Provider Name | Shanita Lashay Gamble |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770230427 PECOS PAC ID: 6608259262 Enrollment ID: I20220815000258 |
| Provider Name | Nathalie Perdomo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457857245 PECOS PAC ID: 4789096504 Enrollment ID: I20220817003604 |
| Provider Name | Neitza Mercedes Hooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861939688 PECOS PAC ID: 9931463478 Enrollment ID: I20221005003715 |
| Provider Name | Alicia Dyane Pelham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326760265 PECOS PAC ID: 9234501883 Enrollment ID: I20230208002817 |
| Provider Name | Katherine Michelle Mitchell-gregory |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255864609 PECOS PAC ID: 3072937366 Enrollment ID: I20230211000223 |
| Provider Name | Leva Talton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316595226 PECOS PAC ID: 4183096548 Enrollment ID: I20230211000247 |
| Provider Name | Lenore Cappelluti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588669923 PECOS PAC ID: 7911940317 Enrollment ID: I20230315000577 |
| Provider Name | Yaima Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609414135 PECOS PAC ID: 6608286208 Enrollment ID: I20230417001055 |
| Provider Name | Autumn Meriwether |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801462635 PECOS PAC ID: 2668832783 Enrollment ID: I20230720000952 |
| Provider Name | Bahaa Amer |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1306293709 PECOS PAC ID: 8820325400 Enrollment ID: I20230829000013 |
| Provider Name | Paulna Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497183693 PECOS PAC ID: 4880817832 Enrollment ID: I20230922002829 |
| Provider Name | Haseebuddin Ahmed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447857420 PECOS PAC ID: 0143691089 Enrollment ID: I20230927000496 |
| Provider Name | Sapna Dhawan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255656419 PECOS PAC ID: 2264703529 Enrollment ID: I20231129000975 |
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