| Entity Name: | PHYSICIANS MEDICAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 May 2003 (22 years ago) |
| Document Number: | L03000019195 |
| FEI/EIN Number | 200059210 |
| Address: | 825 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711 |
| Mail Address: | 825 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711 |
| ZIP code: | 34711 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164480042 | 2006-05-02 | 2007-09-28 | 235 CITRUS TOWER BLVD, SUITE 104, CLERMONT, FL, 347112712, US | 235 CITRUS TOWER BLVD, SUITE 104, CLERMONT, FL, 347112712, US | |||||||||||||||||||||||||
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| Phone | +1 352-536-1764 |
| Fax | 3525361765 |
Authorized person
| Name | DR. AASHIV N. HARI |
| Role | MANAGER |
| Phone | 3525361764 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME84484 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD FL |
| Number | 13764 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PHYSICIANS MEDICAL GROUP LLC 401(K) PROFIT SHARING PLAN & TRUST | 2022 | 200059210 | 2023-06-20 | PHYSICIANS MEDICAL GROUP LLC | 4 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2023-06-20 |
| Name of individual signing | AASHIV HARI |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 812990 |
| Sponsor’s telephone number | 3525527026 |
| Plan sponsor’s address | 825 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711 |
Signature of
| Role | Plan administrator |
| Date | 2022-07-12 |
| Name of individual signing | AASHIV HARI |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| HARI AASHIV N | Agent | 825 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711 |
| Name | Role | Address |
|---|---|---|
| HARI AASHIV N | Manager | 825 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2012-01-20 | 825 OAKLEY SEAVER DRIVE, CLERMONT, FL 34711 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-07-14 | 825 OAKLEY SEAVER DRIVE, CLERMONT, FL 34711 | No data |
| CHANGE OF MAILING ADDRESS | 2011-07-14 | 825 OAKLEY SEAVER DRIVE, CLERMONT, FL 34711 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-01-03 | HARI, AASHIV NMD | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-24 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-01-31 |
| ANNUAL REPORT | 2019-02-15 |
| ANNUAL REPORT | 2018-02-03 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-22 |
| ANNUAL REPORT | 2015-01-02 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 5860337307 | 2020-04-30 | 0491 | PPP | 825 OAKLEY SEAVER DR, CLERMONT, FL, 34711-1968 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Feb 2025
Sources: Florida Department of State
