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INTERCOASTAL MEDICAL GROUP INC
NPI 1306516208
Family Medicine in Bradenton, FL

Active since September 14, 2021CLIA Certified · 8 labs
11715 RANGELAND PKWY, BRADENTON, FL 34211(941) 538-0001 Get Directions Write a Review

NPPES record last updated: April 8, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 8, 2026, Sep 14, 2021 (2 updates tracked since 2021).

About Intercoastal Medical Group Inc NPPES

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

INTERCOASTAL MEDICAL GROUP INC (NPI 1306516208) is a healthcare organization registered as a family medicine in Bradenton, Florida and active in the NPI registry since September 2021. The organization holds 8 active CLIA laboratory certificates and lists Mark J Ramos, President, as its authorized official.

NPPES Registry Identity

NPI1306516208
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameINTERCOASTAL MEDICAL GROUP INC
Location Address11715 RANGELAND PKWYBradenton, FL 34211-9529
Mailing Address943 S Beneva Rd Ste 306Sarasota, FL 34232-2473 · (941) 955-1108 · Fax (941) 954-4440
Phone(941) 538-0001
Organization SubpartNo
Authorized OfficialMark J RamosPresident · (941) 955-1108
Enumeration DateSeptember 14, 2021
Last NPPES UpdateApril 8, 20262 updates tracked since enumeration
NPPES CertifiedApril 8, 2026
✔ NPI 1306516208 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.

11715 RANGELAND PKWY, Bradenton, FL 34211
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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 9

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 10D2134361

Intercoastal Medical Group, Inc · Bradenton, FL
Active · expires Jul 31, 2027
CLIA Number10D2134361
Laboratory TypePhysician Office
Certificate Effective DateAugust 1, 2025
Certificate Expiration DateJuly 31, 2027
Laboratory DirectorTimothy D. Johnson
Laboratory Phone(941) 538-0001
Laboratory LocationIntercoastal Medical Group, Inc11715 Rangeland Parkway, Bradenton, FL 34211
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D0947809

Intercoastal Medical Group, Inc · Bradenton, FL
Active · expires Jun 23, 2028
CLIA Number10D0947809
Laboratory TypePhysician Office
Certificate Effective DateJune 24, 2026
Certificate Expiration DateJune 23, 2028
Laboratory DirectorTimothy D. Johnson
Laboratory Phone(941) 907-6016
Laboratory LocationIntercoastal Medical Group, Inc11505 Rangeland Pkwy 2nd Fl, Bradenton, FL 34211
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D0974058

Intercoastal Medical Group, Inc · Sarasota, FL
Active · expires May 24, 2028
CLIA Number10D0974058
Laboratory TypePhysician Office
Certificate Effective DateMay 25, 2026
Certificate Expiration DateMay 24, 2028
Laboratory DirectorTimothy D. Johnson
Laboratory Phone(941) 953-5213
Laboratory LocationIntercoastal Medical Group, Inc943 S Beneva Rd - Ste 204, Sarasota, FL 34232
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D0897630

Intercoastal Medical Group, Inc · Sarasota, FL
Active · expires May 5, 2028
CLIA Number10D0897630
Laboratory TypePhysician Office
Certificate Effective DateMay 6, 2026
Certificate Expiration DateMay 5, 2028
Laboratory DirectorTimothy D. Johnson
Laboratory Phone(941) 365-7390
Laboratory LocationIntercoastal Medical Group, Inc921 S Beneva Rd, Sarasota, FL 34232
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D1104511

Intercoastal Medical Group, Inc · Bradenton, FL
Active · expires Sep 2, 2027
CLIA Number10D1104511
Laboratory TypePhysician Office
Certificate Effective DateSeptember 3, 2025
Certificate Expiration DateSeptember 2, 2027
Laboratory DirectorTimothy D. Johnson
Laboratory Phone(941) 362-8662
Laboratory LocationIntercoastal Medical Group, Inc11505 Rangeland Pkwy 1st Fl, Bradenton, FL 34211
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 10D0295576

Intercoastal Medical Group Inc · Sarasota, FL
Active · expires May 18, 2027
CLIA Number10D0295576
Laboratory TypePhysician Office
Certificate Effective DateMay 19, 2025
Certificate Expiration DateMay 18, 2027
Laboratory DirectorDr. Christina L. Warner
Laboratory Phone(941) 952-9544
Laboratory LocationIntercoastal Medical Group Inc943 S Beneva Road 1st Floor - Lab, Sarasota, FL 34232
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 20

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

DR. JUAN CARLOS VIGIL DO
Internal Medicine
11715 RANGELAND PKWY
BRADENTON, FL 34211
Manatee County (941) 538-0001
ALLISON BLAIR BLUNDEN PA-C
Physician Assistant
11715 RANGELAND PKWY
BRADENTON, FL 34211
Manatee County (941) 538-0001
DR. ROBERT JAMES SUMMERLEE M.D.
Internal Medicine (Gastroenterology)
11715 RANGELAND PKWY
BRADENTON, FL 34211
Manatee County (941) 538-0092
MR. MICHAEL ERNST HUDACK ARNP
Nurse Practitioner
11715 RANGELAND PKWY
BRADENTON, FL 34211
Manatee County (941) 538-0092
CHRISTIAN JOSUE LORENZO MD
Internal Medicine (Cardiovascular Disease)
11715 RANGELAND PKWY
BRADENTON, FL 34211
Manatee County (321) 841-3581
JOVANNA DENISE MORRISON ARNP
Nurse Practitioner
11715 RANGELAND PKWY
BRADENTON, FL 34211
Manatee County (941) 538-0088
TAYLOR LLOYD DODGEN
Dermatology
11715 RANGELAND PKWY
BRADENTON, FL 34211
Manatee County (941) 538-0022
JEFFREY GRETZ MD
Internal Medicine (Gastroenterology)
11715 RANGELAND PKWY
BRADENTON, FL 34211
Manatee County (941) 538-0092

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 Intercoastal Medical Group Inc's NPI number?

The NPI number for Intercoastal Medical Group Inc is 1306516208. It was assigned to this organization in the NPPES registry on September 14, 2021.

Where is Intercoastal Medical Group Inc located?

Intercoastal Medical Group Inc is located at 11715 Rangeland Pkwy, Bradenton, FL 34211. The listed phone number is (941) 538-0001.

What is Intercoastal Medical Group Inc's specialty?

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

Does Intercoastal Medical Group Inc 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 Intercoastal Medical Group Inc accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Intercoastal Medical Group Inc 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 Intercoastal Medical Group Inc was last updated on April 8, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.