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FLORIDA PRIMARY CARE AND SPORTS MEDICINE, INC.
NPI 1548819741
Family Medicine in Palm Coast, FL

Active since September 10, 2019CLIA 10D2173533 · Waiver
140 PINNACLES DR, PALM COAST, FL 32164(386) 597-2829(386) 313-1923 Get Directions Write a Review

NPPES record last updated: July 1, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 1, 2025, Dec 10, 2019, Sep 10, 2019 (3 updates tracked since 2019).

About Florida Primary Care And Sports Medicine, Inc. NPPES

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

FLORIDA PRIMARY CARE AND SPORTS MEDICINE, INC. (NPI 1548819741) is a healthcare organization registered as a family medicine in Palm Coast, Florida and active in the NPI registry since September 2019. The organization holds a CLIA Waiver certificate valid through October 14, 2027 and lists Ann Shaw, Administrator, as its authorized official.

NPPES Registry Identity

NPI1548819741
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameFLORIDA PRIMARY CARE AND SPORTS MEDICINE, INC.
Location Address140 PINNACLES DRPalm Coast, FL 32164-2322
Mailing Address6 Office Park DrPalm Coast, FL 32137-3808 · (386) 447-6615 · Fax (386) 447-1266
Phone(386) 597-2829
Fax(386) 313-1923
Organization SubpartNo
Authorized OfficialAnn ShawAdministrator · (386) 447-6615
Enumeration DateSeptember 10, 2019
Last NPPES UpdateJuly 1, 20253 updates tracked since enumeration
NPPES CertifiedJuly 1, 2025
✔ NPI 1548819741 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ 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.
Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X
140 PINNACLES DR, Palm Coast, FL 32164
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CLIA Laboratory Certificates CMS CLIA

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 10D2173533

Florida Primary Care And Sports Medicine Inc · Palm Coast, FL
Active · expires Oct 14, 2027
CLIA Number10D2173533
Laboratory TypePhysician Office
Certificate Effective DateOctober 15, 2025
Certificate Expiration DateOctober 14, 2027
Laboratory DirectorBrian T. Bogdanowicz
Laboratory Phone(386) 597-2829
Laboratory LocationFlorida Primary Care And Sports Medicine Inc140 Pinnacles Dr Rm 1, Palm Coast, FL 32164
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

MARLENE BENNETT APRN
Nurse Practitioner (Family)
140 PINNACLES DR
PALM COAST, FL 32164
Flagler County (386) 597-2829
NATALIE ANN INGERSKI APRN, FNP-BC
Nurse Practitioner (Family)
140 PINNACLES DR
PALM COAST, FL 32164
Flagler County (386) 313-6035
CRH MQ LLC
Clinic/Center
140 PINNACLES DR
PALM COAST, FL 32164
Flagler County (386) 597-2829

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 Florida Primary Care And Sports Medicine, Inc.'s NPI number?

The NPI number for Florida Primary Care And Sports Medicine, Inc. is 1548819741. It was assigned to this organization in the NPPES registry on September 10, 2019.

Where is Florida Primary Care And Sports Medicine, Inc. located?

Florida Primary Care And Sports Medicine, Inc. is located at 140 Pinnacles Dr, Palm Coast, FL 32164. The listed phone number is (386) 597-2829.

What is Florida Primary Care And Sports Medicine, Inc.'s specialty?

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

Does Florida Primary Care And Sports Medicine, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2173533) is associated with this NPI, valid through October 14, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Florida Primary Care And Sports Medicine, Inc. was last updated on July 1, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.