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MILLENNIUM PHYSICIAN GROUP LLC
NPI 1124790910
Family Medicine in Port Charlotte, FL

Active since September 30, 2021CLIA Certified · 2 labs
19621 COCHRAN BLVD, PORT CHARLOTTE, FL 33948(855) 674-4624(941) 883-8386 Get Directions Write a Review

NPPES record last updated: January 18, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jan 18, 2023, Sep 30, 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 1124790910) is a healthcare organization registered as a family medicine in Port Charlotte, Florida and active in the NPI registry since September 2021. The organization holds 2 active CLIA laboratory certificates and lists Mary Haltigan, Director Of Revenue Cycle, as its authorized official.

NPPES Registry Identity

NPI1124790910
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameMILLENNIUM PHYSICIAN GROUP LLC
Location Address19621 COCHRAN BLVDPort Charlotte, FL 33948-2070
Mailing Address2675 Winkler Ave Fl 2Fort Myers, FL 33901-9342 · (877) 856-3774 · Fax (239) 599-2612
Phone(855) 674-4624
Fax(941) 883-8386
Organization SubpartNo
Authorized OfficialMary HaltiganDirector Of Revenue Cycle · (877) 856-3774
Enumeration DateSeptember 30, 2021
Last NPPES UpdateJanuary 18, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 18, 2023
✔ NPI 1124790910 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.
19621 COCHRAN BLVD, Port Charlotte, FL 33948
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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 2

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 10D2329908

Millennium Physician Group LLC · Port Charlotte, FL
Active · expires Sep 7, 2027
CLIA Number10D2329908
Laboratory TypePhysician Office
Certificate Effective DateSeptember 8, 2025
Certificate Expiration DateSeptember 7, 2027
Laboratory DirectorJackovic Marcy
Laboratory Phone(941) 787-7665
Laboratory LocationMillennium Physician Group LLC17912 Toledo Blade Blvd, Unit A, Port Charlotte, FL 33948
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D1088558

Millennium Physician Group LLC · Port Charlotte, FL
Active · expires Jul 31, 2027
CLIA Number10D1088558
Laboratory TypePhysician Office
Certificate Effective DateAugust 1, 2025
Certificate Expiration DateJuly 31, 2027
Laboratory DirectorDavid L. Mcatee
Laboratory Phone(941) 764-1880
Laboratory LocationMillennium Physician Group LLC19531 Cochran Blvd, Port Charlotte, FL 33948
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 7

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

DAVID FLESZAR D.O.
Radiology (Diagnostic Radiology)
19621 COCHRAN BLVD
PORT CHARLOTTE, FL 33948
Charlotte County (855) 674-4624
SW FLORIDA PAIN CENTER INC
Specialist
19621 COCHRAN BLVD, UNIT #1
PORT CHARLOTTE, FL 33948
Charlotte County (941) 627-9095
MR. PAUL DAVID RATCLIFF JR. DO
Radiology (Diagnostic Radiology)
19621 COCHRAN BLVD
PORT CHARLOTTE, FL 33948
Charlotte County (855) 674-4624
MICHAEL ROZAK MD
Physical Medicine & Rehabilitation
19621 COCHRAN BLVD
PORT CHARLOTTE, FL 33948
Charlotte County (941) 627-9095
STEPHANIE CRUM PA
Pain Medicine (Interventional Pain Medicine)
19621 COCHRAN BLVD
PORT CHARLOTTE, FL 33948
Charlotte County (954) 262-1250
DR. LOUIS KEVIN VALENTE M.D.
Pain Medicine (Interventional Pain Medicine)
19621 COCHRAN BLVD, UNIT #1
PORT CHARLOTTE, FL 33948
Charlotte County (941) 627-9095
DR. ROBERT BALL D.O.
Pain Medicine (Interventional Pain Medicine)
19621 COCHRAN BLVD, UNIT #1
PORT CHARLOTTE, FL 33948
Charlotte County (941) 627-9095

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 1124790910. It was assigned to this organization in the NPPES registry on September 30, 2021.

Where is Millennium Physician Group LLC located?

Millennium Physician Group LLC is located at 19621 Cochran Blvd, Port Charlotte, FL 33948. The listed phone number is (855) 674-4624.

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. 2 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.