PRIMARY CARE GROUP LLC (NPI# 1093016651) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093016651 |
| Entity Type | Organization |
| Organization Name | PRIMARY CARE GROUP LLC |
| Practice Address |
2961 Canada Rd Ste 105 Lakeland TN 38002-4893 |
| Mailing Address |
1211 Union Ave Ste 700 Memphis TN 38104-6638 |
| Practice Telephone | 9013880115 |
| Mailing Telephone | 9015160546 |
| Mailing Fax Number | 9015160528 |
| Enumeration Date | 2010-11-12 |
| Last Update Date | 2014-04-08 |
| Authorized Official Name | WILLIAM R BREEN JR. (SENIOR VP, PHYSICIAN ALIGNMENT) |
| Authorized Official Telephone | 9015160546 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 208M00000X | Hospitalist | Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | RAILROAD MEDICARE | DR2914 | 01 |
| MS | 01450214 | 05 | |
| AR | 194628002 | 05 | |
| TN | BCBS TN | 4290151 | 01 |
| TN | 1522556 | 05 | |
| MS | RAILROAD MEDICARE | DS1812 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609421841 | Primary Care Group LLC | Family Medicine | 2 Westfield Ave, Clark, NJ 07066-3226 | 2019-08-05 |
| 1578163887 | Primary Care Group LLC | Internal Medicine | 743 Hillside Ave, New Hyde Park, NY 11040-2515 | 2020-10-27 |
| Street Address |
2961 CANADA RD STE 105 |
| City | LAKELAND |
| State | TN |
| Zip Code | 38002-4893 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164572285 | Barton L. Powell | Optometrist | 2961 Canada Rd, Ste 104, Lakeland, TN 38002-4893 | 2007-01-11 |
| 1366785677 | Danielle Jaworski Howell | Nurse Practitioner | 2961 Canada Rd, Suite 105, Lakeland, TN 38002-4893 | 2013-04-04 |
| 1104968338 | Optometry Group Enterprises, PC | Optometrist | 2961 Canada Rd, Suite 104, Lakeland, TN 38002-4893 | 2007-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649836636 | Sunshine and Smiles, LLC. | Home Health | 160 Hidden Lake Cove, Arlington, TN 38002 | 2019-05-15 |
| 1679050934 | Alisha James-scott | Nurse Practitioner | 9025 Us-64, Lakeland, TN 38002 | 2018-07-19 |
| 1720577513 | Heavenly Senior Transport Services LLC | Non-emergency Medical Transport (VAN) | 5995 Garret Valley Ln, Arlington, TN 38002 | 2018-05-07 |
| 1962915959 | Southern Dental of Brunswick Pllc | Dentist | 8755 Chaffee Road, Suite 103, Arlington, TN 38002 | 2017-11-13 |
| 1346750619 | Heath Bryan Coleman, Dds of Tennessee II, Pllc | Dentist | 5226 Airline Rd, 121, Arlington, TN 38002 | 2017-10-02 |
| 1528577210 | Celia Mae Noble | Speech-Language Pathologist | 5940 Griffin Rd, Arlington, TN 38002 | 2017-09-25 |
| 1568996064 | Joshua Davis Bravo | Physical Therapist | 5226 Airline Rd Ste 131, Arlington, TN 38002 | 2017-04-12 |
| 1952773053 | West Tennessee Community Homes | Intermediate Care Facility, Mentally Retarded | 11003 Highway 70, Arlington, TN 38002 | 2015-10-28 |
| 1124490222 | West Tennessee Community Homes | Intermediate Care Facility, Mentally Retarded | 11443 Arlington Woods Cove, Arlington, TN 38002 | 2015-10-28 |
| 1245602341 | West Tennessee Community Homes | Intermediate Care Facility, Mentally Retarded | 11455 Arlington Woods Cove, Arlington, TN 38002 | 2015-10-28 |
| Find all providers in zip 38002 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174121909 | Amanda Millican | Family Medicine | 605 Laura Rd, Lakeland, FL 33815-3220 | 2020-10-14 |
| 1093320848 | Katrena Borders Flowers | Family Medicine | 2629 Highlands Creek Way, Lakeland, FL 33813-6301 | 2020-09-09 |
| 1578177523 | Robinson Family Clinic Inc | Family Medicine | 4406 S Florida Ave Ste 30, Lakeland, FL 33813-2176 | 2020-09-06 |
| 1306467311 | Christopher James Miller | Family Medicine | 215 S Elm Rd, Lakeland, FL 33801-2310 | 2020-04-30 |
| 1811480387 | Victoria Anne Morin | Family Medicine | 1463 Town Center Dr, Lakeland, FL 33803-7966 | 2018-06-10 |
| 1467890665 | Rachael Veronique Ollivierre-agard | Family Medicine | 170 Fitzgerald Rd Ste 1, Lakeland, FL 33813-2633 | 2013-06-10 |
| 1740587211 | Javier Andres Diago Benjumea | Family Medicine | 3015 Lakeland Highlands Rd, Lakeland, FL 33803-4339 | 2011-02-18 |
| 1891099792 | Sergio B Seoane Md Pa | Family Medicine | 118 Allamanda Sr, Lakeland, FL 33803 | 2011-01-06 |
| 1063673812 | Avantica Gondi | Family Medicine | 1818 Harden Blvd Ste 120, Lakeland, FL 33803-1813 | 2008-06-24 |
| 1942460902 | Michael Curtiss | Family Medicine | 2039 E Edgewood Dr, Suite B, Lakeland, FL 33803-3601 | 2008-06-12 |
| Find all providers in LAKELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.