SOUTH LAKE OB/GYN (NPI# 1497754121) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497754121 |
| Entity Type | Organization |
| Organization Name | SOUTH LAKE OB/GYN |
| Practice Address |
1099 Citrus Tower Blvd Ste 120 Clermont FL 34711 |
| Practice Telephone | 3522417050 |
| Practice Fax Number | 3522417035 |
| Mailing Telephone | 3522417050 |
| Mailing Fax Number | 3522417035 |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2008-01-28 |
| NPI Deactivation Date | 07/18/2005 |
| NPI Reactivation Date | 2008-01-28 |
| Authorized Official Name | MR. MATTHEW STEPHEN CASAVANT (OWNER) |
| Authorized Official Telephone | 3522417050 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | OS8678 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
1099 CITRUS TOWER BLVD STE 120 |
| City | CLERMONT |
| State | FL |
| Zip Code | 34711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265825152 | Rocky Mountain Holdings, LLC | Ambulance | 1099 Citrus Tower Blvd, Clermont, FL 34711 | 2015-03-17 |
| 1750710778 | South Lake Anesthesia Services, P.a. | Nurse Anesthetist, Certified Registered | 1099 Citrus Tower Blvd, Clermont, FL 34711-1947 | 2013-11-12 |
| 1861707382 | Lance Barnett | Physician Assistant | 1099 Citrus Tower Blvd, Clermont, FL 34711-1947 | 2010-08-09 |
| 1962640383 | Andrew D Karen Md LLC | Obstetrics & Gynecology | 1099 Citrus Tower Blvd, Suite 110, Clermont, FL 34711-1947 | 2009-01-22 |
| 1063511921 | Michael J Clark | Physician Assistant | 1099 Citrus Tower Blvd, Clermont, FL 34711-1947 | 2006-09-21 |
| 1245332873 | Christine Murphy | Emergency Medicine | 1099 Citrus Tower Blvd, Clermont, FL 34711-1947 | 2006-09-03 |
| 1548293947 | Teresa Layman | Nurse Anesthetist, Certified Registered | 1099 Citrus Tower Blvd, Clermont, FL 34711-1947 | 2006-07-09 |
| 1780616599 | Imke Casey | Nurse Anesthetist, Certified Registered | 1099 Citrus Tower Blvd, Clermont, FL 34711-1947 | 2006-07-06 |
| 1073551842 | Martin Fisher | Anesthesiology | 1099 Citrus Tower Blvd, Clermont, FL 34711-1947 | 2006-06-03 |
| 1497709521 | David Scot Ghivizzani | Anesthesiology | 1099 Citrus Tower Blvd, Clermont, FL 34711-1947 | 2006-05-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316546344 | Latricia Richards-smith | Nurse Practitioner | 3301 Hancock Rd, Clermont, FL 34711 | 2020-10-21 |
| 1073130399 | Marissa Johnston | Behavioral Analyst | 355 Citrus Tower Blvd Ste 112, Clermont, FL 34711 | 2020-07-02 |
| 1649839432 | New Foundations Aba Therapy, LLC | Community/Behavioral Health | 4327 S Hwy 27 #176 Clermont, Clermont, FL 34711 | 2019-06-06 |
| 1275006504 | Innovative Medical Management Solutions LLC | Skilled Nursing Facility | 1775 Hooks Street, Clermont, FL 34711 | 2019-01-09 |
| 1851867766 | Chantal P Baptiste | Nurse Practitioner | 2040 Oakley Seaver Dr Ste 300, Clermont, FL 34711 | 2018-10-17 |
| 1346739539 | Jennifer Brennan | Behavior Technician | 365 Citrus Tower Blvd Bldg Ste 106, Clermont, FL 34711 | 2018-05-03 |
| 1689163966 | Chelsea Strickland | Physical Therapy Assistant | 10037 Stockbridge St, Clermont, FL 34711 | 2018-05-02 |
| 1316448921 | Dana Renee Ottalagano | Counselor | 1635 E Highway 50 Ste 204, Clermont, FL 34711 | 2018-02-28 |
| 1306353842 | Center of Change Inc. | General Practice | 235 Citrus Tower Blvd Ste 104, Clermont, FL 34711 | 2018-01-05 |
| 1003328642 | Clermont Radiology LLC | Clinic/Center | 3725 South Highway 27, Suite 104, Clermont, FL 34711 | 2017-11-03 |
| Find all providers in zip 34711 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942660410 | Gloria Perez | Obstetrics & Gynecology | 1900 Don Wickham Dr Ste 130, Clermont, FL 34711-1979 | 2016-02-26 |
| 1437354339 | Michael Gerard Jackson | Obstetrics & Gynecology | 1900 Don Wickham Dr Ste 110, Clermont, FL 34711-1980 | 2007-06-19 |
| 1114969839 | Shelley C Glover | Obstetrics & Gynecology | 1725 E Highway 50, Suite B, Clermont, FL 34711-5188 | 2006-06-11 |
| 1669426656 | Kristina Marie Mclean | Obstetrics & Gynecology | 4200 Hooks Street, Clermont, FL 34711-3514 | 2006-05-22 |
| 1255385779 | Mary Beth Lewis-boardman | Obstetrics & Gynecology | 4200 Hooks Steet, Clermont, FL 34711-3514 | 2006-05-20 |
| 1528010485 | Denise Kazmierczak | Obstetrics & Gynecology | 835 7th St, Clermont, FL 34711-2156 | 2006-05-17 |
| 1003815671 | Matthew Steven Casavant | Obstetrics & Gynecology | 1900 Don Wickham Drive, Ste 120, Clermont, FL 34711-1947 | 2005-07-18 |
| 1386902203 | Giselle Marie Torres | Obstetrics & Gynecology | 2400 Hook St, Clermont, FL 34711-3514 | 2012-04-28 |
| 1558646877 | Amir Homayoun Fazeli | Obstetrics & Gynecology | 1900 Don Wickham Dr Ste 110, Clermont, FL 34711-1980 | 2011-10-18 |
| 1629360938 | Debra Ortiz | Obstetrics & Gynecology | 2400 Hook St, Clermont, FL 34711-3514 | 2011-05-04 |
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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.