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MILLENNIUM PHYSICIAN GROUP LLC
NPI 1063175958
Family Medicine in Port Charlotte, FL

Active since October 18, 2021CLIA Certified · 8 labs
2315 AARON ST, PORT CHARLOTTE, FL 33952(941) 613-2222(941) 627-9950 Get Directions Write a Review

NPPES record last updated: January 18, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 18, 2023, Oct 18, 2021 (2 updates tracked since 2021).

About Millennium Physician Group Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MILLENNIUM PHYSICIAN GROUP LLC (NPI 1063175958) is a healthcare organization registered as a family medicine in Port Charlotte, Florida and active in the NPI registry since October 2021. The organization holds 8 active CLIA laboratory certificates and lists Mary Haltigan, Director Of Revenue Circle, as its authorized official.

NPPES Registry Identity

NPI1063175958
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameMILLENNIUM PHYSICIAN GROUP LLC
Location Address2315 AARON STPort Charlotte, FL 33952-5305
Mailing Address2675 Winkler Ave Fl 2Fort Myers, FL 33901-9342 · (877) 856-3774
Phone(941) 613-2222
Fax(941) 627-9950
Organization SubpartNo
Authorized OfficialMary HaltiganDirector Of Revenue Circle · (877) 856-3774
Enumeration DateOctober 18, 2021
Last NPPES UpdateJanuary 18, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 18, 2023
✔ NPI 1063175958 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
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.
2315 AARON ST, Port Charlotte, FL 33952
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

CLIA Laboratory Certificates CMS CLIA 8

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D1094348

Millennium Physician Group LLC · Port Charlotte, FL
Active · expires Jan 14, 2027
CLIA Number10D1094348
Laboratory TypePhysician Office
Certificate Effective DateJanuary 15, 2025
Certificate Expiration DateJanuary 14, 2027
Laboratory DirectorDr. George Nackley
Laboratory Phone(941) 235-3447
Laboratory LocationMillennium Physician Group LLC2315 Aaron St, Port Charlotte, FL 33952
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D1000073

Millennium Physician Group, LLC · Port Charlotte, FL
Active · expires Jun 2, 2028
CLIA Number10D1000073
Laboratory TypePhysician Office
Certificate Effective DateJune 3, 2026
Certificate Expiration DateJune 2, 2028
Laboratory DirectorTerence Connelly
Laboratory Phone(941) 787-7665
Laboratory LocationMillennium Physician Group, LLC3340 Tamiami Trl, Port Charlotte, FL 33952
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2177689

Millennium Physician Group · Port Charlotte, FL
Active · expires Jan 15, 2028
CLIA Number10D2177689
Laboratory TypePhysician Office
Certificate Effective DateJanuary 16, 2026
Certificate Expiration DateJanuary 15, 2028
Laboratory DirectorDavid L. Mcatee
Laboratory Phone(941) 787-7665
Laboratory LocationMillennium Physician Group4130 Tamiami Trail Suite 2, Port Charlotte, FL 33952
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D1049106

Millennium Physician Group LLC · Port Charlotte, FL
Active · expires Dec 21, 2027
CLIA Number10D1049106
Laboratory TypePhysician Office
Certificate Effective DateDecember 22, 2025
Certificate Expiration DateDecember 21, 2027
Laboratory DirectorJason Nazar
Laboratory Phone(941) 787-7665
Laboratory LocationMillennium Physician Group LLC3390 Tamiami Trl Ste 105, Port Charlotte, FL 33952
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2176386

Millennium Physician Group, LLC · Port Charlotte, FL
Active · expires Dec 12, 2027
CLIA Number10D2176386
Laboratory TypePhysician Office
Certificate Effective DateDecember 13, 2025
Certificate Expiration DateDecember 12, 2027
Laboratory DirectorFelipe Collares
Laboratory Phone(941) 787-7665
Laboratory LocationMillennium Physician Group, LLC3430 Tamiami Trail Suite B, Port Charlotte, FL 33952
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D1016466

Millennium Physician Group, LLC · Port Charlotte, FL
Active · expires Aug 28, 2027
CLIA Number10D1016466
Laboratory TypePhysician Office
Certificate Effective DateAugust 29, 2025
Certificate Expiration DateAugust 28, 2027
Laboratory DirectorLuis A. Casanova
Laboratory Phone(941) 787-7665
Laboratory LocationMillennium Physician Group, LLC3508 Tamiami Trail Suite C, Port Charlotte, FL 33952
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MAUREEN ANN WERTZ ARNP
Nurse Practitioner (Family)
2315 AARON ST
PORT CHARLOTTE, FL 33952
Charlotte County (855) 674-7700
DR. GLADYS PEREZ M.D.
Family Medicine
2315 AARON ST
PORT CHARLOTTE, FL 33952
Charlotte County (941) 979-5700
DR. IRENA KRASTEVA GESHEVA MD
Family Medicine
2315 AARON ST
PORT CHARLOTTE, FL 33952
Charlotte County (941) 613-2222
DR. NUMA JOSE TAMAYO MD
Internal Medicine (Endocrinology, Diabetes & Metabolism)
2315 AARON ST
PORT CHARLOTTE, FL 33952
Charlotte County (941) 613-2222
DR. RAYMOND R BURGESS D.O.
Family Medicine
2315 AARON ST
PORT CHARLOTTE, FL 33952
Charlotte County (941) 613-2222

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Millennium Physician Group LLC's NPI number?

The NPI number for Millennium Physician Group LLC is 1063175958. It was assigned to this organization in the NPPES registry on October 18, 2021.

Where is Millennium Physician Group LLC located?

Millennium Physician Group LLC is located at 2315 Aaron St, Port Charlotte, FL 33952. The listed phone number is (941) 613-2222.

What is Millennium Physician Group LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Millennium Physician Group LLC hold CLIA laboratory certificates?

Yes. 8 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Millennium Physician Group LLC accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Millennium Physician Group LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Millennium Physician Group LLC was last updated on January 18, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.