| Family Health Source | |
|
216 N. Frederick Street Pierson FL 32180 | |
| (386) 202-6025 | |
| (386) 200-4563 |
| Full Name | Family Health Source |
|---|---|
| Speciality | Clinic/Center |
| Location | 216 N. Frederick Street, Pierson, Florida |
| Authorized Official Name and Position | Dina Geoghegan (CREDENTIALING/CONTRACTS ADMIN) |
| Authorized Official Contact | 3863274781 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Health Source 1205 S Woodland Blvd Ste 3 Deland FL 32720-7464 Ph: (386) 202-6025 | Family Health Source 216 N. Frederick Street Pierson FL 32180 Ph: (386) 202-6025 |
| NPI Number | 1992792311 |
|---|---|
| Provider Enumeration Date | 09/30/2005 |
| Last Update Date | 03/16/2023 |
| Certification Date | 03/16/2023 |
| Medicare PECOS PAC ID | 0547249518 |
|---|---|
| Medicare Enrollment ID | O20040819000233 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992792311 | NPI | - | NPPES |
| 687955100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (NU) | Primary |
| Provider Name | John M Ham Ying |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780683870 PECOS PAC ID: 6002870748 Enrollment ID: I20041112000970 |
| Provider Name | Bruno Mancini |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861448052 PECOS PAC ID: 2365535978 Enrollment ID: I20070912000188 |
| Provider Name | Hussain Rawji |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1932168721 PECOS PAC ID: 9830261536 Enrollment ID: I20091102000118 |
| Provider Name | Robert O Kessack |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1497708952 PECOS PAC ID: 0547254856 Enrollment ID: I20101027001120 |
| Provider Name | David M Jackson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1952338485 PECOS PAC ID: 2466638002 Enrollment ID: I20110517000425 |
| Provider Name | Angela Kathleen Beech |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1538317383 PECOS PAC ID: 5890965065 Enrollment ID: I20110825000188 |
| Provider Name | Robert Brian Rodriguez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1619236338 PECOS PAC ID: 3971767377 Enrollment ID: I20120615000140 |
| Provider Name | Teresa Ann Bowers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255744223 PECOS PAC ID: 6406075274 Enrollment ID: I20150928001435 |
| Provider Name | Rachel Macalua |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1508230384 PECOS PAC ID: 3870898281 Enrollment ID: I20160223002071 |
| Provider Name | Kelsey Hoblick |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1366953135 PECOS PAC ID: 9830456300 Enrollment ID: I20171208001409 |
| Provider Name | Shruti Patel |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1417404237 PECOS PAC ID: 1052674652 Enrollment ID: I20180412002385 |
| Provider Name | Roberto Baldassarre |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1730673062 PECOS PAC ID: 4587917208 Enrollment ID: I20181026001182 |
| Provider Name | Melody Koback |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952802043 PECOS PAC ID: 6901161926 Enrollment ID: I20190926001070 |
| Provider Name | Flor Toledo |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1225672850 PECOS PAC ID: 0941639637 Enrollment ID: I20200401000057 |
| Provider Name | Craig Hardy |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1740544626 PECOS PAC ID: 6002067584 Enrollment ID: I20210830001127 |
| Provider Name | Vianey Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073376133 PECOS PAC ID: 1557708666 Enrollment ID: I20240524002164 |
| Provider Name | Susan Hamoui |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1518490630 PECOS PAC ID: 8426490723 Enrollment ID: I20240531000012 |
| Provider Name | Mia Milena Alonzo Santiago |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1427886076 PECOS PAC ID: 1557800711 Enrollment ID: I20240831000452 |
| Provider Name | Pedro Ortiz |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1629502463 PECOS PAC ID: 6608316328 Enrollment ID: I20240909004546 |
| Provider Name | Alondra Ortiz De Jesus |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1740019371 PECOS PAC ID: 8224579206 Enrollment ID: I20240917004900 |
| Provider Name | Jorge L Martinez Bruna |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1093544876 PECOS PAC ID: 5890236590 Enrollment ID: I20240922000005 |
| Provider Name | Madison Mckenzie Zaferatos |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1902635360 PECOS PAC ID: 0840723714 Enrollment ID: I20241030002895 |
| Provider Name | Vanessa Tomoah |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1487534731 PECOS PAC ID: 9638654387 Enrollment ID: I20260331000775 |
| Provider Name | Toneia Ariana Washington |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1972474674 PECOS PAC ID: 5395217715 Enrollment ID: I20260617001716 |
| Provider Name | Diana Small |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063392801 PECOS PAC ID: 9537632112 Enrollment ID: I20260625000305 |
Family Health Source Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 216 Frederick St, Pierson, FL 32180 Phone: 386-749-9449 Fax: 386-749-9447 |