MEDICARE: PSGFL MSSP, 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1689557936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSGFL MSSP, LLC

Provider Business Mailing Address
First Line	:	3000 GULF BREEZE PKWY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-5623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 GULF BREEZE PKWY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-5623
Country	:	US
Telephone Number	:	864-303-8650
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	CHRISTOPHER R DENAPOLES, M.D.
Credential	:
Telephone Number	:	864-303-8650

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	04/23/2026

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