MEDICARE: SEBASTIAN HMA PHYSICIAN MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207T00000X	Neurological Surgery Physician
2	207R00000X	Internal Medicine Physician
3	207X00000X	Orthopaedic Surgery Physician
4	363L00000X	Nurse Practitioner
5	363A00000X	Physician Assistant
6	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1154424703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEBASTIAN HMA PHYSICIAN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	5811 PELICAN BAY BLVD
Second Line	:	STE 500
City	:	NAPLES
State	:	FL
Zip	:	34108-2704
Country	:	US
Telephone Number	:	239-598-3131
Fax Number	:	239-592-0438

Provider Business Practice Location Address
First Line	:	13000 US HIGHWAY 1
Second Line	:	SUITE 5
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-3773
Country	:	US
Telephone Number	:	772-589-2992
Fax Number	:	772-581-8331

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MICHAEL L GINGRAS
Credential	:
Telephone Number	:	239-598-3131

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	04/22/2013

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