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  5. ENRIQUE UMPIERRE MD, PLLC

ENRIQUE UMPIERRE MD, PLLC

Company Details

Entity Name: ENRIQUE UMPIERRE MD, PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 03 Aug 2015 (10 years ago)
Last Event: CORPORATE MERGER
Event Date Filed: 02 Nov 2015 (9 years ago)
Document Number: L15000141894
FEI/EIN Number 01-0791070
Address: 3727 N. GOLDENROD ROAD, 103, WINTER PARK, FL, 32792, US
Mail Address: 4243 NW Federal Highway, Jensen Beach, FL, 34957, US
ZIP code: 32792
County: Orange
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1811175516 2008-02-05 2023-08-02 3727 N GOLDENROD RD, SUITE 103, WINTER PARK, FL, 327928611, US 3727 N GOLDENROD RD, SUITE 103, WINTER PARK, FL, 327928611, US

Contacts
Phone +1 407-673-9533
Fax 4076731442

Authorized person
Name ENRIQUE GERARDO UMPIERRE-SCHUCK
Role OWNER / PHYSICIAN
Phone 4076739533

Taxonomy
Taxonomy Code 261QP3300X - Pain Clinic/Center
License Number ME81176
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 267621400
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ENRIQUE UMPIERRE MD PLLC 401(K) PROFIT SHARING PLAN & TRUST 2022 010791070 2023-07-24 ENRIQUE UMPIERRE MD PLLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-06-01
Business code 621111
Sponsor’s telephone number 4076739533
Plan sponsor’s address 3727 N GOLDENROD ROAD, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2023-07-24
Name of individual signing LILIANA UMPIERRE
Valid signature Filed with authorized/valid electronic signature
ENRIQUE UMPIERRE MD PLLC 401(K) PROFIT SHARING PLAN & TRUST 2022 010791070 2023-10-18 ENRIQUE UMPIERRE MD PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-06-01
Business code 621111
Sponsor’s telephone number 4076739533
Plan sponsor’s address 3727 N GOLDENROD ROAD, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2023-10-18
Name of individual signing LILIANA UMPIERRE
Valid signature Filed with authorized/valid electronic signature
ENRIQUE UMPIERRE MD PLLC 401(K) PROFIT SHARING PLAN & TRUST 2021 010791070 2022-07-26 ENRIQUE UMPIERRE MD PLLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-06-01
Business code 621111
Sponsor’s telephone number 4076739533
Plan sponsor’s address 3727 N GOLDENROD ROAD, SUITE 103, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2022-07-26
Name of individual signing LILIANA UMPIERRE
Valid signature Filed with authorized/valid electronic signature
ENRIQUE UMPIERRE MD PLLC 401(K) PROFIT SHARING PLAN & TRUST 2020 010791070 2021-07-29 ENRIQUE UMPIERRE MD PLLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-06-01
Business code 621111
Sponsor’s telephone number 4076739533
Plan sponsor’s address 3727 N GOLDENROD ROAD, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2021-07-29
Name of individual signing LILIANA UMPIERRE
Valid signature Filed with authorized/valid electronic signature
ENRIQUE UMPIERRE MD PLLC 401(K) PROFIT SHARING PLAN & TRUST 2019 010791070 2020-07-09 ENRIQUE UMPIERRE MD PLLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-06-01
Business code 621111
Sponsor’s telephone number 4076739533
Plan sponsor’s address 3727 N GOLDENROD ROAD, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2020-07-09
Name of individual signing LILIANA UMPIERRE
Valid signature Filed with authorized/valid electronic signature
ENRIQUE UMPIERRE MD PLLC 401 K PROFIT SHARING PLAN TRUST 2018 010791070 2019-10-10 ENRIQUE UMPIERRE MD PLLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-06-01
Business code 621111
Sponsor’s telephone number 4076739533
Plan sponsor’s address 3727 N GOLDENROD ROAD, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2019-10-10
Name of individual signing LILIANA UMPIERRE
Valid signature Filed with authorized/valid electronic signature
ENRIQUE UMPIERRE MD PLLC 401 K PROFIT SHARING PLAN TRUST 2017 010791070 2019-10-10 ENRIQUE UMPIERRE MD PLLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-06-01
Business code 621111
Sponsor’s telephone number 4076739533
Plan sponsor’s address 3727 N GOLDENROD ROAD, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2019-10-10
Name of individual signing LILIANA UMPIERRE
Valid signature Filed with authorized/valid electronic signature
ENRIQUE UMPIERRE MD PLLC 401 K PROFIT SHARING PLAN TRUST 2016 010791070 2017-07-12 ENRIQUE UMPIERRE MD PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-06-01
Business code 621111
Sponsor’s telephone number 4076739533
Plan sponsor’s address 3727 N GOLDENROD ROAD, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2017-07-12
Name of individual signing LILIANA UMPIERRE
Valid signature Filed with authorized/valid electronic signature
ENRIQUE UMPIERRE MD PA 401 K PROFIT SHARING PLAN TRUST 2015 010791070 2016-07-26 ENRIQUE UMPIERRE MD PLLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-06-01
Business code 621111
Sponsor’s telephone number 4076739533
Plan sponsor’s address 3727 N GOLDENROD ROAD, SUITE 103, WINTER PARK, FL, 32792

Signature of
Role Plan administrator
Date 2016-07-26
Name of individual signing LILIANA UMPIERRE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
UMPIERRE ENRIQUE MD Agent 3727 N. GOLDENROD ROAD, WINTER PARK, FL, 32792

Manager

Name Role Address
UMPIERRE ENRIQUE MD Manager 3727 N. GOLDENROD ROAD, SUITE 103, WINTER PARK, FL, 32792

Chief Executive Officer

Name Role Address
Gerjevic Joshua Chief Executive Officer 4243 NW Federal Highway, Jensen Beach, FL, 34957

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G15000122290 CENTRAL FLORIDA PAIN & REHAB CLINIC ACTIVE 2015-12-04 2025-12-31 No data 3727 N GOLDENROD ROAD, SUITE 103, WINTER PARK, FL, 32792-8611

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2025-01-06 3727 N. GOLDENROD ROAD, 103, WINTER PARK, FL 32792 No data
MERGER 2015-11-02 No data CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 500000155355

Documents

Name Date
ANNUAL REPORT 2025-01-06
ANNUAL REPORT 2024-04-03
ANNUAL REPORT 2023-04-19
ANNUAL REPORT 2022-04-26
ANNUAL REPORT 2021-04-12
ANNUAL REPORT 2020-05-06
ANNUAL REPORT 2019-04-22
ANNUAL REPORT 2018-04-09
ANNUAL REPORT 2017-04-16
ANNUAL REPORT 2016-03-31

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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