| Entity Name: | CENTRAL FLORIDA INPATIENT MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Oct 2013 (11 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 05 Dec 2024 (2 months ago) |
| Document Number: | L13000152119 |
| FEI/EIN Number | 59-3718647 |
| Address: | 525 Technology Park, Lake Mary, FL, 32746, US |
| Mail Address: | 525 Technology Park, Lake Mary, FL, 32746, US |
| ZIP code: | 32746 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649228859 | 2006-05-04 | 2024-07-18 | PO BOX 102224, ATLANTA, GA, 303687746, US | 525 TECHNOLOGY PARK STE 109, LAKE MARY, FL, 327467107, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 407-647-2346 |
| Fax | 4076475431 |
Authorized person
| Name | SHANNON ABBOTT |
| Role | CEO |
| Phone | 4076472346 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME80505 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 117229400 |
| State | FL |
| Issuer | FHHS |
| Number | 56966 |
| State | FL |
| Issuer | UHC |
| Number | 8900052 |
| State | FL |
| Issuer | CIGNA |
| Number | 2289953 |
| State | FL |
| Issuer | RR MEDICARE |
| Number | DA4377 |
| State | FL |
| Issuer | BCBS |
| Number | 38407 |
| State | FL |
| Issuer | AETNA HMO |
| Number | 2571358 |
| State | FL |
| Issuer | AETNA PPO |
| Number | 7014260 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SPECTRUM MEDICAL PARTNERS, INC. 401(K) PROFIT SHARING PLAN | 2023 | 593718647 | 2024-10-09 | CENTRAL FLORIDA INPATIENT MEDICINE, LLC | 162 | |||||||||||||
|
||||||||||||||||||
| CENTRAL FLORIDA INPATIENT MEDICINE, P.A. 401(K) PROFIT SHARING PLAN | 2019 | 593718647 | 2020-07-07 | CENTRAL FLORIDA INPATIENT MEDICINE, LLC | 112 | |||||||||||||
|
||||||||||||||||||
| CENTRAL FLORIDA INPATIENT MEDICINE, P.A. 401(K) PROFIT SHARING PLAN | 2018 | 593718647 | 2019-07-16 | CENTRAL FLORIDA INPATIENT MEDICINE, LLC | 100 | |||||||||||||
|
||||||||||||||||||
| Name | Role | Address |
|---|---|---|
| Corporation Company of Miami (GLT) | Agent | 200 S. Biscayne Blvd., Suite 4100, Miami, FL, 33131 |
| Name | Role | Address |
|---|---|---|
| Masters Brian | Secretary | 525 Technology Park, Lake Mary, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| Crum James | President | 525 Technology Park, Lake Mary, FL, 32746 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000102487 | NORTH FLORIDA POST ACUTE | ACTIVE | 2024-08-28 | 2029-12-31 | No data | 525 TECHNOLOGY PARK SUITE 109, LAKE MARY, FL, 32746 |
| G24000079933 | SAFE TRANSITIONS HOME | ACTIVE | 2024-07-02 | 2029-12-31 | No data | 525 TECHNOLOGY PARK SUITE 109, LAKE MARY, FL, 32746 |
| G24000070753 | WOUND CARE SPECIALTY PARTNERS | ACTIVE | 2024-06-06 | 2029-12-31 | No data | 525 TECHNOLOGY PARK, STE 109, LAKE MARY, FL, 32746 |
| G24000027757 | ICS POST ACUTE | ACTIVE | 2024-02-21 | 2029-12-31 | No data | 525 TECHNOLOGY PARK SUITE 109, LAKE MARY, FL, 32746 |
| G22000086325 | NORTH FLORIDA INPATIENT MEDICINE | ACTIVE | 2022-07-21 | 2027-12-31 | No data | 525 TECHNOLOGY PARK, SUITE 109, LAKE MARY, FL, 32746 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-04-20 | Corporation Company of Miami (GLT) | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-20 | 200 S. Biscayne Blvd., Suite 4100, Miami, FL 33131 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-25 | 525 Technology Park, Suite 109, Lake Mary, FL 32746 | No data |
| CHANGE OF MAILING ADDRESS | 2017-04-25 | 525 Technology Park, Suite 109, Lake Mary, FL 32746 | No data |
| CONVERSION | 2013-10-28 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P01000048013. CONVERSION NUMBER 500000135545 |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-12-05 |
| ANNUAL REPORT | 2023-04-20 |
| AMENDED ANNUAL REPORT | 2022-10-21 |
| ANNUAL REPORT | 2022-04-14 |
| AMENDED ANNUAL REPORT | 2021-10-19 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-04-15 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-04-25 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
