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  5. ANASTASIA MEDICAL GROUP LLC

ANASTASIA MEDICAL GROUP LLC

Company Details

Entity Name: ANASTASIA MEDICAL GROUP LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 11 May 2005 (20 years ago)
Document Number: L05000046806
FEI/EIN Number 611488381
Address: 1301 PLANTATION ISLAND DR, SUITE 203A, ST AUGUSTINE, FL, 32080
Mail Address: 1301 PLANTATION ISLAND DR, SUITE 203A, ST AUGUSTINE, FL, 32080, US
ZIP code: 32080
County: St. Johns
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1710940648 2006-04-11 2024-01-15 1301 PLANTATION ISLAND DRIVE, SUITE 203A, ST AUGUSTINE, FL, 32080, US 1301 PLANTATION ISLAND DRIVE, SUITE 203A, ST AUGUSTINE, FL, 32080, US

Contacts
Phone +1 904-461-0821
Fax 9044610823

Authorized person
Name SUHAS P NEERUKONDA
Role MANAGING PARTNER
Phone 9044610343

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes
Taxonomy Code 207RE0101X - Endocrinology, Diabetes & Metabolism Physician
Is Primary No
Taxonomy Code 213E00000X - Podiatrist
Is Primary No

Other Provider Identifiers
Issuer BCBS
Number 99767
State FL
Issuer MEDICAID
Number 277020200
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ANASTASIA MEDICAL GROUP LLC 401(K) PROFIT SHARING PLAN & TRUST 2023 611488381 2024-05-07 ANASTASIA MEDICAL GROUP LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9044610821
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 203A, SAINT AUGUSTINE, FL, 320803111

Signature of
Role Plan administrator
Date 2024-05-07
Name of individual signing SUHAS NEERUKONDA
Valid signature Filed with authorized/valid electronic signature
ANASTASIA MEDICAL GROUP LLC 401(K) PROFIT SHARING PLAN & TRUST 2022 611488381 2023-05-17 ANASTASIA MEDICAL GROUP LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9044610821
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE SUITE, SAINT AUGUSTINE, FL, 320803111

Signature of
Role Plan administrator
Date 2023-05-17
Name of individual signing SUHAS NEERUKONDA
Valid signature Filed with authorized/valid electronic signature
ANASTASIA MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2021 611488381 2022-05-16 ANASTASIA MEDICAL GROUP, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9044610821
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE SUITE, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2022-05-16
Name of individual signing SUHAS NEERUKONDA
Valid signature Filed with authorized/valid electronic signature
ANASTASIA MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2020 611488381 2021-05-17 ANASTASIA MEDICAL GROUP, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9044610821
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE SUITE, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2021-05-17
Name of individual signing SUHAS NEERUKONDA
Valid signature Filed with authorized/valid electronic signature
ANASTASIA MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2019 611488381 2020-04-29 ANASTASIA MEDICAL GROUP, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9044610821
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE SUITE, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2020-04-29
Name of individual signing SUHAS NEERUKONDA
Valid signature Filed with authorized/valid electronic signature
ANASTASIA MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2018 611488381 2019-05-15 ANASTASIA MEDICAL GROUP, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9044610821
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE SUITE, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2019-05-15
Name of individual signing SUHAS NEERUKONDA
Valid signature Filed with authorized/valid electronic signature
ANASTASIA MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2017 611488381 2018-07-02 ANASTASIA MEDICAL GROUP, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9044610821
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE SUITE, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2018-07-02
Name of individual signing SUHAS NEERUKONDA
Valid signature Filed with authorized/valid electronic signature
ANASTASIA MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2016 611488381 2017-04-24 ANASTASIA MEDICAL GROUP 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9044610821
Plan sponsor’s address 1301 PLANTATION ISLAND DR, STE 203A, ST. AUGUSTINE, FL, 320803110

Signature of
Role Plan administrator
Date 2017-04-24
Name of individual signing SUHAS NEERUKONDA
Valid signature Filed with authorized/valid electronic signature
ANASTASIA MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2015 611488381 2016-07-25 ANASTASIA MEDICAL GROUP 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9044610821
Plan sponsor’s address 1301 PLANTATION ISLAND DR, STE 203A, ST. AUGUSTINE, FL, 320803110

Signature of
Role Plan administrator
Date 2016-07-25
Name of individual signing SUHAS NEERUKONDA
Valid signature Filed with authorized/valid electronic signature
ANASTASIA MEDICAL GROUP 401(K) PROFIT SHARING PLAN 2014 611488381 2015-06-08 ANASTASIA MEDICAL GROUP 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9044610821
Plan sponsor’s address 1301 PLANTATION ISLAND DR, STE 203A, ST. AUGUSTINE, FL, 320803110

Signature of
Role Plan administrator
Date 2015-06-08
Name of individual signing SUHAS NEERUKONDA
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
NEERUKONDA SUHAS P Agent 1301 PLANTATION ISLAND DRIVE, SAINT AUGUSTINE, FL, 32080

Managing Member

Name Role Address
NEERUKONDA SUHAS Managing Member 432 MARSHPOINT CIRCLE, ST AUGUSTINE, FL, 32080
PEREIRA RYAN Managing Member 201 Inlet Drive, ST AUGUSTINE, FL, 32080

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2015-01-14 1301 PLANTATION ISLAND DR, SUITE 203A, ST AUGUSTINE, FL 32080 No data
REGISTERED AGENT NAME CHANGED 2012-02-08 NEERUKONDA, SUHAS P No data
REGISTERED AGENT ADDRESS CHANGED 2011-09-21 1301 PLANTATION ISLAND DRIVE, 203A, SAINT AUGUSTINE, FL 32080 No data
CHANGE OF PRINCIPAL ADDRESS 2010-01-11 1301 PLANTATION ISLAND DR, SUITE 203A, ST AUGUSTINE, FL 32080 No data

Documents

Name Date
ANNUAL REPORT 2025-01-10
ANNUAL REPORT 2024-01-19
ANNUAL REPORT 2023-01-24
ANNUAL REPORT 2022-01-12
ANNUAL REPORT 2021-01-12
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-01-25
ANNUAL REPORT 2018-01-23
ANNUAL REPORT 2017-01-24
ANNUAL REPORT 2016-02-16

Related by officers

NEERUKONDA SUHAS

SUHAS NEERUKONDA, M.D., LLC PHANSEM LLC SENEPE LLC

PEREIRA RYAN

AXION APPAREL LLC GLOBAL WATER FOUNDATION INC. THE LIMB CARE CENTER LLC SENEPE LLC QUAD ANCHOR INVESTMENTS LLC.

NEERUKONDA SUHAS P

HARBOR ISLAND LASER CENTER, LLC SUHAS NEERUKONDA, M.D., LLC PHANSEM LLC SENEPE LLC

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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