| Anastasia Medical Group, LLC | |
|
1301 Plantation Island Drive Suite 203a St Augustine FL 32080 | |
| (904) 461-0821 | |
| (904) 461-0823 |
| Full Name | Anastasia Medical Group, LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 1301 Plantation Island Drive, St Augustine, Florida |
| Authorized Official Name and Position | Suhas P Neerukonda (MANAGING PARTNER) |
| Authorized Official Contact | 9044610343 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Anastasia Medical Group, LLC 1301 Plantation Island Drive Suite 203a St Augustine FL 32080 Ph: (904) 461-0821 | Anastasia Medical Group, LLC 1301 Plantation Island Drive Suite 203a St Augustine FL 32080 Ph: (904) 461-0821 |
| NPI Number | 1710940648 |
|---|---|
| Provider Enumeration Date | 04/11/2006 |
| Last Update Date | 01/15/2024 |
| Certification Date | 01/15/2024 |
| Medicare PECOS PAC ID | 6709889926 |
|---|---|
| Medicare Enrollment ID | O20060808000532 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710940648 | NPI | - | NPPES |
| 99767 | Other | FL | BCBS |
| 277020200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (NU) | Secondary |
| 213E00000X | Podiatrist | (NU) | Secondary |
| Provider Name | Ryan J Pereira |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1033195979 PECOS PAC ID: 5597781880 Enrollment ID: I20051017000196 |
| Provider Name | Suhas P Neerukonda |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538145602 PECOS PAC ID: 3375569668 Enrollment ID: I20051017000252 |
| Provider Name | Cindy Ortiz Chaconas |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1518339761 PECOS PAC ID: 8729364518 Enrollment ID: I20170410001690 |
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