| Entity Name: | OPTUMCARE FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 09 Aug 2019 (5 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 30 Sep 2024 (4 months ago) |
| Document Number: | M19000007681 |
| FEI/EIN Number | 87-0408859 |
| Address: | 2175 PARK PL, EL SEGUNDO, CA, 90245, US |
| Mail Address: | 2175 PARK PL, EL SEGUNDO, CA, 90245, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659884294 | 2017-11-06 | 2022-09-06 | 5130 SUNFOREST DR STE 300, TAMPA, FL, 336346327, US | 5130 SUNFOREST DR STE 300, TAMPA, FL, 336346327, US | |||||||||||||||||||||||||||
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| Phone | +1 727-824-0780 |
| Fax | 7275686011 |
Authorized person
| Name | LAURENE ANN DOUGHERTY |
| Role | SR VP OF INTEGRATION & TRANSFORMAT |
| Phone | 7278282322 |
Taxonomy
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA BLUE |
| Number | 33249 |
| State | FL |
| Issuer | MEDICAID |
| Number | 269895100 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| OPTUMCARE HOLDINGS, LLC | Member | 2175 PARK PL, EL SEGUNDO, CA, 90245 |
| Name | Role | Address |
|---|---|---|
| COMSTOCK TROY MD | Chief Executive Officer | 2175 PARK PL, EL SEGUNDO, CA, 90245 |
| Name | Role | Address |
|---|---|---|
| ZIMMERMAN JOSEPH A | Chief Financial Officer | 2175 PARK PL, EL SEGUNDO, CA, 90245 |
| Name | Role | Address |
|---|---|---|
| HIRSCH MARILYN V | Treasurer | 2175 PARK PL, EL SEGUNDO, CA, 90245 |
| Name | Role | Address |
|---|---|---|
| LIETHEN JOHN G | Secretary | 2175 PARK PL, EL SEGUNDO, CA, 90245 |
| Name | Role | Address |
|---|---|---|
| LANG HEATHER | Asst | 2175 PARK PL, EL SEGUNDO, CA, 90245 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000157402 | JSA HEALTHCARE CORPORATION | ACTIVE | 2022-12-21 | 2027-12-31 | No data | 2175 PARK PLACE, EL SEGUNDO, CA, 90245 |
| G19000120297 | OPTUM | ACTIVE | 2019-11-08 | 2029-12-31 | No data | 2175 PARK PLACE, EL SEGUNDO, CA, 90245 |
| G19000108375 | DAVITA MEDICAL GROUP | EXPIRED | 2019-10-04 | 2024-12-31 | No data | 10051 5TH STREET N., SUITE 200, ST. PETERSBURG, FL, 33702 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2024-09-30 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2024-09-30 | 2175 PARK PL, EL SEGUNDO, CA 90245 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-09-30 | 2175 PARK PL, EL SEGUNDO, CA 90245 | No data |
| LC AMENDMENT | 2024-03-19 | No data | No data |
| LC AMENDMENT | 2021-10-05 | No data | No data |
| LC AMENDMENT | 2021-05-28 | No data | No data |
| LC AMENDMENT | 2020-04-09 | No data | No data |
| LC AMENDMENT | 2020-03-27 | No data | No data |
| LC AMENDMENT | 2019-09-06 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-06 |
| LC Amendment | 2024-09-30 |
| ANNUAL REPORT | 2024-04-21 |
| LC Amendment | 2024-03-19 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-04-21 |
| LC Amendment | 2021-10-05 |
| LC Amendment | 2021-05-28 |
| ANNUAL REPORT | 2021-04-24 |
| AMENDED ANNUAL REPORT | 2020-08-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
