LIVE WELL M.D. (NPI# 1992019640) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992019640 |
| Entity Type | Organization |
| Organization Name | LIVE WELL M.D. |
| Practice Address |
11512 Lake Mead Ave Building 521 Jacksonville FL 32256-9680 |
| Practice Telephone | 9048079747 |
| Practice Fax Number | 9048079746 |
| Mailing Telephone | 9048079747 |
| Mailing Fax Number | 9048079746 |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2010-08-04 |
| Authorized Official Name | ALEX MOORE (DOCTOR) |
| Authorized Official Telephone | 9048079747 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305R00000X | Preferred Provider Organization | Managed Care Organizations |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | LIVE WELL MEDICAL CARE P.C. | 123 Church Avenue, Brooklyn, Ny 11218 |
| Street Address |
11512 LAKE MEAD AVE BUILDING 521 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32256-9680 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205831906 | Jerome O Sugar | Otolaryngology | 11512 Lake Mead Ave, Ste 531, Jacksonville, FL 32256-9680 | 2005-06-17 |
| 1952949166 | Savannah Moore | Speech-Language Pathologist | 11512 Lake Mead Ave, Jacksonville, FL 32256-9680 | 2019-12-18 |
| 1225594427 | Celena Allen | Nurse Practitioner | 11512 Lake Mead Ave, Jacksonville, FL 32256-9680 | 2019-02-13 |
| 1306300017 | Tara Elizabeth Strange | Speech-Language Pathologist | 11512 Lake Mead Ave, Jacksonville, FL 32256-9680 | 2019-01-27 |
| 1457826810 | Annette Marie Tharp-wright | Counselor | 11512 Lake Mead Ave, Jacksonville, FL 32256-9680 | 2018-10-11 |
| 1023515418 | Samantha J Barry | Nurse Practitioner | 11512 Lake Mead Ave, Jacksonville, FL 32256-9680 | 2018-04-11 |
| 1073068235 | Juliann Abecassis | Acupuncturist | 11512 Lake Mead Ave, Suite 605, Jacksonville, FL 32256-9680 | 2016-08-17 |
| 1568915387 | Jacksonville Dental Specialists | Dentist | 11512 Lake Mead Ave, Ste. 532, Jacksonville, FL 32256-9680 | 2016-07-28 |
| 1972957272 | Kayla Raulerson | Behavioral Analyst | 11512 Lake Mead Ave, Suite 601, Jacksonville, FL 32256-9680 | 2016-04-22 |
| 1710331830 | Anna Beth Baden | Behavioral Analyst | 11512 Lake Mead Ave, Suite 601, Jacksonville, FL 32256-9680 | 2016-04-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841890464 | Alice Sanchez | Dietitian, Registered | 7643 Gate Parkway, Suite 104-1128, Jacksonville, FL 32256 | 2020-11-01 |
| 1093327702 | Oaktree Dental LLC | Clinic/Center | 14595 Philips Highway, Jacksonville, FL 32256 | 2020-08-24 |
| 1538787866 | Tywanna Council | Massage Therapist | 4720 Salisbury Road #102, Jacksonville, FL 32256 | 2020-07-13 |
| 1275155368 | Christy Orellana | Social Worker | 5011 Gate Parkway Bldg 100 Suite 100, Jacksonville, FL 32256 | 2020-05-11 |
| 1376175117 | Diane Stover | Case Manager/Care Coordinator | 7001 A. C. Skinner Parkway, Jacksonville, FL 32256 | 2020-02-10 |
| 1982235859 | Sandra Josefina Baez Nunez | Nurse Practitioner | 10739 Deerwood Park Blvd, Suite 200, Jacksonville, FL 32256 | 2020-01-30 |
| 1205476496 | Point Meadows Dental Center, Inc. | Dentist | 10915 Baymeadows Rd, #106, Jacksonville, FL 32256 | 2020-01-15 |
| 1598324113 | Dhaval Yogeshkumar Shah | Dentist | 8206 Philips Hwy., Suite 21, Jacksonville, FL 32256 | 2019-06-07 |
| 1003472499 | Dade Medical, Inc. | Durable Medical Equipment & Medical Supplies | 9143 Philips Highway Suite 270, Jacksonville, FL 32256 | 2019-05-13 |
| 1003479726 | Nichole Bashara | Behavior Technician | 8383 Baymeadows Rd, Jacksonville, FL 32256 | 2019-04-18 |
| Find all providers in zip 32256 | ||||
| Taxonomy Code | 305R00000X |
| Grouping | Managed Care Organizations |
| Classification | Preferred Provider Organization |
| A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891188173 | Julington Creek Pediatrics | Preferred Provider Organization | 774 State Road 13 Ste 6, Jacksonville, FL 32259-3815 | 2015-03-11 |
| 1760881163 | First Coast Medical Associates LLC | Preferred Provider Organization | 13241 Bartram Park Blvd Unit 413, Jacksonville, FL 32258-5237 | 2014-08-21 |
| 1891031910 | Mandarin Family Medicine, P.a. | Preferred Provider Organization | 12276-210 San Jose Blvd, Jacksonville, FL 32223 | 2012-12-18 |
| 1124195573 | Lakeshore Medical Care Center, Inc | Preferred Provider Organization | 4616 San Juan Ave, Jacksonville, FL 32210-3228 | 2006-11-29 |
| 1487737441 | Midtown Dental of Jacksonville | Preferred Provider Organization | 2801 Saint Johns Bluff Rd S, Suite 1, Jacksonville, FL 32246-3761 | 2006-10-23 |
| 1609241918 | Lysandro O. Tapnio Dmd Pa | Preferred Provider Organization | 9272 Arlington Expy, Jacksonville, FL 32225-8212 | 2015-12-11 |
| 1306189683 | T & R Inc | Preferred Provider Organization | 4131 University Blvd S Ste 4a, Jacksonville, FL 32216-4322 | 2013-04-04 |
| 1922361732 | Psi Family Services, Inc. | Preferred Provider Organization | 3890 Dunn Ave, 1104, Jacksonville, FL 32218-6428 | 2012-06-18 |
| 1932475167 | Medsports Promassage | Preferred Provider Organization | 3491 Pall Mall Dr, Suite 104, Jacksonville, FL 32257-5449 | 2012-04-02 |
| 1487891859 | Lymphedema Care Center of North Florida, Inc. | Preferred Provider Organization | 8563 Argyle Business Loop, Suite #2, Jacksonville, FL 32244-6668 | 2009-01-07 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32256 |
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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.