THE CENTER FOR FUNCTIONAL AESTHETIC AND ANTI AGING MEDICINE INC
NPI 1508682089
Internal Medicine in Winter Haven, FL

Q: What is The Center For Functional Aesthetic And Anti Aging Medicine Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Active since November 29, 2024

571 AVENUE K SE, WINTER HAVEN, FL 33880(407) 440-0708 Get Directions Write a Review

NPPES record last updated: November 29, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About The Center For Functional Aesthetic And Anti Aging Medicine Inc NPPES

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

THE CENTER FOR FUNCTIONAL AESTHETIC AND ANTI AGING MEDICINE INC (NPI 1508682089) is a healthcare organization registered as an internal medicine in Winter Haven, Florida and active in the NPI registry since November 2024. The organization lists Danice Blaise, Chief Executive Officer, Owner, as its authorized official.

NPPES Registry Identity

NPI1508682089

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameTHE CENTER FOR FUNCTIONAL AESTHETIC AND ANTI AGING MEDICINE INC

Location Address571 AVENUE K SEWinter Haven, FL 33880-4215

Mailing Address571 Avenue K SeWinter Haven, FL 33880-4215 · (407) 440-0708

Phone(407) 440-0708

Organization SubpartNo

Authorized OfficialDanice BlaiseChief Executive Officer, Owner · (954) 681-0068

Enumeration DateNovember 29, 2024

NPPES CertifiedNovember 28, 2024

✔ NPI 1508682089 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedNaturopathTaxonomy 175F00000X

Also ListedPreventive Medicine · Obesity MedicineTaxonomy 2083B0002X

571 AVENUE K SE, Winter Haven, FL 33880

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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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

The Center For Functional Aesthetic And Anti Aging Medicine Inc 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 The Center For Functional Aesthetic And Anti Aging Medicine Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Danice Blaise, MD,MBA

General Practice

NPI 1255829966

684 STATE ROAD 60 W
Lake Wales, FL 33853

(863) 949-4868

✔ PECOS✔ Accepts Medicare11 mi

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 The Center For Functional Aesthetic And Anti Aging Medicine Inc's NPI number?

The NPI number for The Center For Functional Aesthetic And Anti Aging Medicine Inc is 1508682089. It was assigned to this organization in the NPPES registry on November 29, 2024.

Where is The Center For Functional Aesthetic And Anti Aging Medicine Inc located?

The Center For Functional Aesthetic And Anti Aging Medicine Inc is located at 571 Avenue K SE, Winter Haven, FL 33880. The listed phone number is (407) 440-0708.

What is The Center For Functional Aesthetic And Anti Aging Medicine Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is The Center For Functional Aesthetic And Anti Aging Medicine Inc enrolled in Medicare?

Yes. The Center For Functional Aesthetic And Anti Aging Medicine Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through The Center For Functional Aesthetic And Anti Aging Medicine Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (General Practice) reassigns their Medicare billing to The Center For Functional Aesthetic And Anti Aging Medicine Inc. 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 The Center For Functional Aesthetic And Anti Aging Medicine Inc was last updated on November 29, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months 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.