| Entity Name: | PHYSICIANS FOR ACCOUNTABLE CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Apr 2012 (13 years ago) |
| Last Event: | CONVERSION |
| Event Date Filed: | 24 Apr 2012 (13 years ago) |
| Document Number: | L12000055750 |
| FEI/EIN Number | 58-1645419 |
| Address: | 922 Rolling Acres Road, Lady Lake, FL, 32159, US |
| Mail Address: | 922 Rolling Acres Rd., Lady Lake, FL, 32159, US |
| ZIP code: | 32159 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124014709 | 2005-09-20 | 2022-03-15 | 922 ROLLING ACRES RD STE 1, LADY LAKE, FL, 321595037, US | 922 ROLLING ACRES RD STE 1, LADY LAKE, FL, 321595037, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 352-674-6300 |
| Fax | 5275363993 |
| Fax | 3537536399 |
Authorized person
| Name | REBECCA GROHLER |
| Role | MANAGER |
| Phone | 3526746300 |
Taxonomy
| Taxonomy Code | 2085R0001X - Radiation Oncology Physician |
| Is Primary | Yes |
| Taxonomy Code | 208800000X - Urology Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | RR MEDICARE |
| Number | C12688 |
| State | FL |
| Issuer | MEDICAID |
| Number | 061970100 |
| State | FL |
| Name | Role |
|---|---|
| WALSH BANKS PLLC | Agent |
| Name | Role | Address |
|---|---|---|
| Catalano David JDr. | Manager | 922 Rolling Acres Road, Lady Lake, FL, 32159 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000037680 | INTERCOMMUNITY CANCER CENTERS | ACTIVE | 2020-04-02 | 2025-12-31 | No data | 922 ROLLING ACRES ROAD, SUITE 1E, LADY LAKE, FL, 32159 |
| G12000089082 | INTERCOMMUNITY CANCER CENTERS | EXPIRED | 2012-09-11 | 2017-12-31 | No data | 301 SOUTH LAKE STREET, LEESBURG, FL, 34748 |
| G12000089078 | UROLOGY ASYSOCIATES OF LAKE COUNT | EXPIRED | 2012-09-11 | 2017-12-31 | No data | 801 NORTHSHORE DRIVE, EUSTIS, FL, 32726 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-14 | 922 Rolling Acres Road, Lady Lake, FL 32159 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-14 | 922 Rolling Acres Road, Lady Lake, FL 32159 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-14 | 228 Hillcrest Street, Orlando, FL 32801 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-12-08 | Walsh Banks, PLLC | No data |
| CONVERSION | 2012-04-24 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS A21644. CONVERSION NUMBER 300000122033 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-07 |
| ANNUAL REPORT | 2023-03-14 |
| ANNUAL REPORT | 2022-03-14 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-02-14 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-03-01 |
| ANNUAL REPORT | 2017-01-30 |
| AMENDED ANNUAL REPORT | 2016-12-08 |
| ANNUAL REPORT | 2016-01-26 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
