| Entity Name: | BERNADETTE SANTOS MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 04 Oct 2012 (12 years ago) |
| Document Number: | P12000084035 |
| FEI/EIN Number | 46-1133252 |
| Address: | 1503 Buenos Aires Blvd, The Villages, FL, 32159, US |
| Mail Address: | 1503 Buenos Aires Blvd, The Villages, FL, 32159, US |
| ZIP code: | 32159 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578800454 | 2013-01-11 | 2018-05-29 | 121A LAGRANDE BLVD STE A, LADY LAKE, FL, 321591302, US | 1503 BUENOS AIRES BLVD STE 180, THE VILLAGES, FL, 32159, US | |||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-753-0581 |
| Fax | 3527532078 |
| Phone | +1 352-323-1482 |
| Fax | 3522590748 |
Authorized person
| Name | DR. BERNADETTE SANTOS |
| Role | OWNER |
| Phone | 3527530581 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME81152 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 143942097 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD PROVIDER NUMBER |
| Number | 51617 |
| State | FL |
| Issuer | TRICARE PROVIDER NUMBER |
| Number | 143942097 |
| State | FL |
| Issuer | RAILROAD MEDICARE PROVIDER NUMBER |
| Number | P00601026 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BERNADETTE SANTOS, MD, PA 401(K) PLAN | 2019 | 461133252 | 2020-06-23 | BERNADETTE SANTOS, MD, PA | 4 | |||||||||||||
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| BERNADETTE SANTOS, MD, PA 401(K) PLAN | 2018 | 461133252 | 2019-09-20 | BERNADETTE SANTOS, MD, PA | 4 | |||||||||||||
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| BERNADETTE SANTOS, MD, PA 401(K) PLAN | 2017 | 461133252 | 2018-09-05 | BERNADETTE SANTOS, MD, PA | 3 | |||||||||||||
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| BERNADETTE SANTOS, MD, PA 401(K) PLAN | 2016 | 461133252 | 2017-06-15 | BERNADETTE SANTOS, MD, PA | 2 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| SANTOS BERNADETTE | Agent | 1503 Buenos Aires Blvd, The Villages, FL, 32159 |
| Name | Role | Address |
|---|---|---|
| SANTOS BERNADETTE | President | 1503 Buenos Aires Blvd, The Villages, FL, 32159 |
| Name | Role | Address |
|---|---|---|
| SANTOS BERNADETTE | Vice President | 1503 Buenos Aires Blvd, The Villages, FL, 32159 |
| Name | Role | Address |
|---|---|---|
| SANTOS BERNADETTE | Secretary | 1503 Buenos Aires Blvd, The Villages, FL, 32159 |
| Name | Role | Address |
|---|---|---|
| SANTOS BERNADETTE | Treasurer | 1503 Buenos Aires Blvd, The Villages, FL, 32159 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2020-03-07 | 1503 Buenos Aires Blvd, Bldg. 180, The Villages, FL 32159 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-07 | 1503 Buenos Aires Blvd, Bldg. 180, The Villages, FL 32159 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-02-22 | 1503 Buenos Aires Blvd, Bldg. 180, The Villages, FL 32159 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-04 |
| ANNUAL REPORT | 2023-01-29 |
| ANNUAL REPORT | 2022-02-06 |
| ANNUAL REPORT | 2021-03-04 |
| ANNUAL REPORT | 2020-03-07 |
| ANNUAL REPORT | 2019-02-22 |
| ANNUAL REPORT | 2018-04-01 |
| ANNUAL REPORT | 2017-02-26 |
| ANNUAL REPORT | 2016-01-24 |
| ANNUAL REPORT | 2015-01-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
