MEDICARE: PRIMUS MEDICAL GROUP LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1245107580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMUS MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	2240 W WOOLBRIGHT RD STE 317
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-6364
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10817 S JOG RD STE 230
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-0912
Country	:	US
Telephone Number	:	561-634-8888
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	RICHARD LUCIBELLA
Credential	:
Telephone Number	:	561-634-8888

Provider Enumeration Date	:	10/21/2025
Last Update Date	:	10/21/2025

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