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BURNT STORE FAMILY MEDICINE P L
NPI 1164739421
Family Medicine in Punta Gorda, FL

Active since September 08, 2010
100 MADRID BLVD, SUITE 513, PUNTA GORDA, FL 33950(941) 505-0974(941) 505-8517 Get Directions Write a Review

NPPES record last updated: June 23, 2011. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Burnt Store Family Medicine P L NPPES

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

BURNT STORE FAMILY MEDICINE P L (NPI 1164739421) is a healthcare organization registered as a family medicine in Punta Gorda, Florida and active in the NPI registry since September 2010. The organization lists Gordon Wang, Owner, as its authorized official.

NPPES Registry Identity

NPI1164739421
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameBURNT STORE FAMILY MEDICINE P L
Location Address100 MADRID BLVD, SUITE 513Punta Gorda, FL 33950-7968
Mailing Address100 Madrid Blvd, Suite 513Punta Gorda, FL 33950-7968 · (941) 505-0974 · Fax (941) 505-8517
Phone(941) 505-0974
Fax(941) 505-8517
Organization SubpartNo
Authorized OfficialGordon WangOwner · (941) 505-0974
Enumeration DateSeptember 8, 2010
Last NPPES UpdateJune 23, 2011
✔ NPI 1164739421 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in FL · ME0072508
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.
100 MADRID BLVD, Punta Gorda, FL 33950
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Other Identifiers 1

Medicare PINEZ857AFL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Burnt Store Family Medicine P L is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Burnt Store Family Medicine P L, which bills Medicare for the services this clinician delivers.

Clinician (1)

Gordon Wang, MD
Family Practice
NPI 1174517205
100 MADRID BLVD 513
Punta Gorda, FL 33950
(941) 505-0974
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Burnt Store Family Medicine P L's NPI number?

The NPI number for Burnt Store Family Medicine P L is 1164739421. It was assigned to this organization in the NPPES registry on September 8, 2010.

Where is Burnt Store Family Medicine P L located?

Burnt Store Family Medicine P L is located at 100 Madrid Blvd Suite 513, Punta Gorda, FL 33950. The listed phone number is (941) 505-0974.

What is Burnt Store Family Medicine P L's specialty?

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

Is Burnt Store Family Medicine P L enrolled in Medicare?

Yes. Burnt Store Family Medicine P L is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Burnt Store Family Medicine P L?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Burnt Store Family Medicine P L. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Burnt Store Family Medicine P L was last updated on June 23, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.