| Entity Name: | PCA MEDICAL GROUP, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 09 Apr 1993 (32 years ago) |
| Date of dissolution: | 27 Sep 2016 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 27 Sep 2016 (8 years ago) |
| Document Number: | P93000026827 |
| FEI/EIN Number | 59-3176364 |
| Address: | 1715 N Westshore Blvd, Suite 780, Tampa, FL 33607 |
| Mail Address: | 1715 N Westshore Blvd, Suite 780, Tampa, FL 33607 |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144415837 | 2007-09-06 | 2016-03-14 | 1715 N WEST SHORE BLVD, SUITE 780, TAMPA, FL, 336073932, US | 34650 US 19 N, SUITE 104, PALM HARBOR, FL, 346842155, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-440-4402 |
| Fax | 8134404407 |
| Phone | +1 727-789-2922 |
| Fax | 7277874288 |
Authorized person
| Name | MR. C. ROSS BERRY |
| Role | PRESIDENT & CEO |
| Phone | 8134404402 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 006386604 |
| State | FL |
| Issuer | MEDICAID |
| Number | 006386607 |
| State | FL |
| Issuer | MEDICAID |
| Number | 006386602 |
| State | FL |
| Issuer | MEDICAID |
| Number | 006386606 |
| State | FL |
| Issuer | MEDICAID |
| Number | 006386601 |
| State | FL |
| Issuer | MEDICAID |
| Number | 006386608 |
| State | FL |
| Issuer | MEDICAID |
| Number | 006386605 |
| State | FL |
| Issuer | MEDICAID |
| Number | 006386600 |
| State | FL |
| Issuer | MEDICAID |
| Number | 006386603 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PCA MEDICAL GROUP INC 401 K PROFIT SHARING PLAN TRUST | 2015 | 593176364 | 2016-04-19 | PCA MEDICAL GROUP INC | 59 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2016-04-19 |
| Name of individual signing | C. ROSS BERRY |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Berry, C. Ross | Agent | 1715 N Westshore Blvd, Suite 780, Tampa, FL 33607 |
| Name | Role | Address |
|---|---|---|
| Berry, C. Ross | President | 1715 N Westshore Blvd, Suite 780 Tampa, FL 33607 |
| Name | Role | Address |
|---|---|---|
| Berry, C. Ross | Chief Executive Officer | 1715 N Westshore Blvd, Suite 780 Tampa, FL 33607 |
| Name | Role | Address |
|---|---|---|
| Edwards, Jeffrey s | Chief Financial Officer | 1715 N Westshore Blvd, Suite 780 Tampa, FL 33607 |
| Name | Role | Address |
|---|---|---|
| Chandra, Samarth | Secretary | 601 Lexington Ave, 55th Floor New York, NY 10022 |
| Name | Role | Address |
|---|---|---|
| Chandra, Samarth | Treasurer | 601 Lexington Ave, 55th Floor New York, NY 10022 |
| Name | Role | Address |
|---|---|---|
| Chandra, Samarth | Director | 601 Lexington Ave, 55th Floor New York, NY 10022 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000034400 | STARUS MEDICAL GROUP | EXPIRED | 2014-04-07 | 2019-12-31 | No data | 1715 N. WESTSHORE BLVD., SUITE 780, TAMPA, FL, 33607 |
| G14000027507 | SYNGEIA MEDICAL GROUP | EXPIRED | 2014-03-18 | 2019-12-31 | No data | 1715 N. WESTSHORE BLVD., SUITE 780, TAMPA, FL, 33607 |
| G13000048155 | PRIMARY CARE ASSOCIATES | EXPIRED | 2013-05-21 | 2018-12-31 | No data | 3001 NORTH ROCKY POINT DRIVE EAST, SUITE 200, TAMPA, FL, 33607 |
| G12000079413 | PCA MEDICAL GROUP | EXPIRED | 2012-08-10 | 2017-12-31 | No data | 3001 NORTH ROCKY POINT DRIVE, EAST, SUITE 200, TAMPA, FL, 33607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2016-09-27 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-03-13 | 1715 N Westshore Blvd, Suite 780, Tampa, FL 33607 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-03-13 | 1715 N Westshore Blvd, Suite 780, Tampa, FL 33607 | No data |
| CHANGE OF MAILING ADDRESS | 2015-03-13 | 1715 N Westshore Blvd, Suite 780, Tampa, FL 33607 | No data |
| REGISTERED AGENT NAME CHANGED | 2015-03-13 | Berry, C. Ross | No data |
| NAME CHANGE AMENDMENT | 2013-04-17 | PCA MEDICAL GROUP, INC. | No data |
| AMENDED AND RESTATEDARTICLES/NAME CHANGE | 2012-03-08 | MEHUL K. PATEL, M.D., INC. | No data |
| MERGER | 2001-12-31 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 300000040213 |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2016-09-27 |
| ANNUAL REPORT | 2016-02-18 |
| ANNUAL REPORT | 2015-03-13 |
| ANNUAL REPORT | 2014-03-14 |
| ANNUAL REPORT | 2013-04-22 |
| Name Change | 2013-04-17 |
| Amended/Restated Article/NC | 2012-03-08 |
| ANNUAL REPORT | 2012-02-13 |
| ANNUAL REPORT | 2011-01-06 |
| ANNUAL REPORT | 2010-01-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
