PREMIUM MEDICAL CLINIC PA (NPI# 1730407420) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730407420 |
| Entity Type | Organization |
| Organization Name | PREMIUM MEDICAL CLINIC PA |
| Practice Address |
12211 Regency Village Dr Suite 2 Orlando FL 32821-7813 |
| Practice Telephone | 4072123060 |
| Practice Fax Number | 8776447808 |
| Mailing Telephone | 4072123060 |
| Mailing Fax Number | 8776447808 |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2012-02-01 |
| Authorized Official Name | DR. SAFAA ABDEL-AL (PRESIDENT/OWNER) |
| Authorized Official Telephone | 4072123060 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | ME97108 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 002150900 | 05 | |
| FL | BCBS | 1465P | 01 |
| Street Address |
12211 REGENCY VILLAGE DR SUITE 2 |
| City | ORLANDO |
| State | FL |
| Zip Code | 32821-7813 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548885460 | Holiday Cvs LLC | Durable Medical Equipment & Medical Supplies | 11619 Daryl Carter Parkway, Orlando, FL 32821 | 2020-06-16 |
| 1740527811 | Medical Home Alliance LLC | Internal Medicine | 6675 Westwood Blvd Ste 475, Orlando, FL 32821 | 2013-01-10 |
| 1215298385 | Steven C Batchelor | Case Manager/Care Coordinator | 5334 Central Florida Parkway #123, Orlando, FL 32821 | 2012-06-05 |
| 1811267859 | Kon Ying Leung | Pharmacist | 12650 International Drive South, Orlando, FL 32821 | 2012-01-09 |
| 1700085297 | Jill Brightman Bello | Social Worker | 5314 Dorrington Ln, Orlando, FL 32821 | 2007-07-13 |
| 1952320947 | Michell Lyn Arnow Phd Pa | Psychologist | 5007 Gateway Avenue, Suite B, Orlando, FL 32821 | 2006-07-19 |
| 1205824513 | Nusrath Hasan Baig | Psychiatry & Neurology | 6601 Central Florida Parkway, Central Florida Behavioral Hospital, Orlando, FL 32821 | 2005-10-11 |
| 1225188253 | Linda Bisnauth | Psychiatry & Neurology | 6601 Central Florida Parkway, Central Florida Behavioral Hospital, Orlando, FL 32821 | 2007-01-11 |
| 1376047530 | Nathaniel Edward Dash | Occupational Therapy Assistant | 6627 Tanglewood Bay Dr, Apt 1105, Orlando, FL 32821-3282 | 2018-03-22 |
| 1891229712 | Christopher Wilcox | Social Worker | 8807 Villa View Cir, 202, Orlando, FL 32821-4112 | 2017-04-18 |
| Find all providers in zip 32821 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891329355 | Brittani Newport | Pediatrics | 10743 Narcoossee Rd Ste A13, Orlando, FL 32832-6946 | 2020-02-24 |
| 1467091959 | Jennifer Dolcater Ketchersid | Pediatrics | 2501 N Orange Ave Ste 586, Orlando, FL 32804-4603 | 2019-12-31 |
| 1396250098 | Advanced Kid's Care | Pediatrics | 98 Terra Mango Loop, Unit 12, Orlando, FL 32835 | 2017-12-05 |
| 1467977454 | Physician Associates LLC | Pediatrics | 14065 Town Loop Blvd Ste 300, Orlando, FL 32837-6199 | 2017-08-10 |
| 1609320837 | Starus Pediatrics LLC | Pediatrics | 6001 Vineland Rd Ste 103, Orlando, FL 32819-7829 | 2016-08-04 |
| 1942656517 | Vijay Mehta | Pediatrics | 60 W Gore St # Mp373, Orlando, FL 32806 | 2016-05-12 |
| 1124401674 | Kelsey Wehrenberg | Pediatrics | 83 Columbia St Ste 202, Orlando, FL 32806 | 2015-07-01 |
| 1396138319 | Premier Physician Associates LLC | Pediatrics | 13651 Hunters Oak Dr, Ste 101, Orlando, FL 32837-7679 | 2015-03-16 |
| 1073917076 | Abdollah Iravani Md Pa | Pediatrics | 2106 N Orange Ave # 100, Orlando, FL 32804-5535 | 2014-10-20 |
| 1720407620 | Christopher Dudek | Pediatrics | 86 W Underwood St Ste 200, Orlando, FL 32806-1110 | 2014-04-08 |
| Find all providers in ORLANDO | ||||
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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.