| NPI |
1538739313 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Entity Type Code |
2 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Employer Identification Number EIN |
|
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Provider Organization Name Legal Business Name |
CAN COMMUNITY HEALTH, INC. |
The last name of the provider. If the provider is an individual, this is the legal name. |
| Provider First Line Business Practice Location Address |
1231 N TUTTLE AVE |
The first name of the provider, if the provider
is an individual. |
| Provider Business Practice Location Address City Name |
SARASOTA |
The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name |
FL |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
| Provider Business Practice Location Address Postal Code |
342373116 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number |
9413660134 |
The telephone number associated with the location address of the provider being identified. |
| Provider Business Practice Location Address Fax Number |
8666223009 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Enumeration Date |
6/25/2021 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date |
1/30/2024 |
The date that a record was last updated or changed. |
| Authorized Official Last Name |
PATEL |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Authorized Official First Name |
RISHI |
The date that a record was last updated or changed. |
| Authorized Official Middle Name |
B |
The code designating the provider’s gender if the provider is a person. |
| Authorized Official Title or Position |
PRESIDENT & CEO |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Authorized Official Telephone Number |
9413004440 |
|
| Healthcare Provider Taxonomy Code 1 |
1223G0001X |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier 1 |
057256026 |
|
| Other Provider Identifier Type Code 1 |
05 |
|
| Other Provider Identifier State 1 |
FL |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| Other Provider Identifier 2 |
21725 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 2 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 2 |
FL |
|
| Other Provider Identifier Issuer 2 |
BCBS FL GROUP # |
|
| Is Organization Subpart |
N |
|
| Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|
| NPI Certification Date |
1/30/2024 |
|