The Center for Functional Aesthetic and Anti Aging Medicine Inc
NPI 1508682089ActiveOrganization· Internal Medicine· Winter Haven, FL
Internal Medicine in Winter Haven, Florida, registered in NPPES in November 2024. The authorized official on file is Danice Blaise, MD, MBA, Chief Executive Officer, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1508682089 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Nov 29, 2024 |
| Last updated in NPPES | Nov 29, 2024 |
| Certified by provider | Nov 28, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Internal Medicine Primary | 207R00000X | — | — |
| Naturopath | 175F00000X | — | — |
| Preventive Medicine, Obesity Medicine | 2083B0002X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (FL) |
|---|
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