ATLANTIC MEDICAL GROUP (NPI# 1144281247) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144281247 |
| Entity Type | Organization |
| Organization Name | ATLANTIC MEDICAL GROUP |
| Practice Address |
1541 S Wickham Rd West Melbourne FL 32904-3540 |
| Practice Telephone | 3217266331 |
| Practice Fax Number | 3217266371 |
| Mailing Telephone | 3217266331 |
| Mailing Fax Number | 3217266371 |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. GEORGE ROQUE (PRESIDENT) |
| Authorized Official Telephone | 3217266331 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | ME88828 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AETNA PROVIDER NO. | 7274610 | 01 | |
| WELLCARE MCAID PROVIDER # | 246370 | 01 | |
| CCN NETWORK PROVIDER NO. | 5585831 | 01 | |
| RAILROAD MCARE GROUP # | DD4702 | 01 | |
| RAILROAD MCARE PROVIDER # | P00022983 | 01 | |
| FLORIDIANCARE PROVIDER # | 10024 | 01 | |
| FIRST HEALTH PROVIDER NO. | 1809978 | 01 | |
| CIGNA PROVIDER NO. | 9303692 | 01 | |
| PHCS PROVIDER # | 9362860 | 01 | |
| PREFERRED CARE PROVIDER # | 159351XX | 01 | |
| BCBS PROVIDER ID | 37972 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558630483 | Atlantic Medical Group | Internal Medicine | 2541 N.queen St, Kinston, NC 28501-3851 | 2011-12-21 |
| 1114391927 | Atlantic Medical Group | Dietitian, Registered | 4 Josh Court, Jacksonville, Nc, NC 28546-5253 | 2015-11-17 |
| 1770968943 | Atlantic Medical Group | Clinic/Center | 3501 Lesh St Ne, Canton, OH 44705-4376 | 2015-07-29 |
| 1720375728 | Atlantic Medical Group | Specialist | 1518 Monte Sano Ave, Augusta, GA 30904-5323 | 2011-06-29 |
| 1962728394 | Atlantic Medical Group | Internal Medicine | 4 Josh Court, Jacksonville, NC 28546-5253 | 2010-04-09 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | ATLANTIC MEDICAL GROUP INC. | 105 Hanover St, Staten Island, Ny 10309 |
| Connecticut Business Registrations | ATLANTIC MEDICAL GROUP, INC. | 116 Granite Street, Westerly, RI 02891 |
| Street Address |
1541 S WICKHAM RD |
| City | WEST MELBOURNE |
| State | FL |
| Zip Code | 32904-3540 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447611835 | Samantha Anderson | Nurse Practitioner | 1541 S Wickham Rd, West Melbourne, FL 32904-3540 | 2016-03-11 |
| 1811071582 | R & R Internal Medicine Services Pa | Internal Medicine | 1541 S Wickham Rd, West Melbourne, FL 32904-3540 | 2006-10-25 |
| 1376505834 | George Roque | Internal Medicine | 1541 S Wickham Rd, West Melbourne, FL 32904-3540 | 2006-04-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063066512 | Shepherd's Heart Ministries | Counselor | 900 S Wickham Rd, Melbourne, FL 32904 | 2019-08-01 |
| 1588138663 | Nicholle C Rothengass | Physician Assistant | 2263 W New Haven Ave # 350, W Melbourne, FL 32904 | 2019-01-11 |
| 1114407020 | Natalie Havkin | Speech-Language Pathologist | 250 S Wickham Rd., Melbourne, FL 32904 | 2018-08-20 |
| 1184119299 | Marni B Simon | Speech-Language Pathologist | 565 Acacia Ave, Melbourne Village, FL 32904 | 2018-06-30 |
| 1821588625 | Walden Psychological Services, LLC | Psychologist | 3400 Willowwood Dr, Melbourne, FL 32904 | 2018-05-16 |
| 1598276271 | Donetta Gwin Reynolds | Early Intervention Provider Agency | 764 Triples Crown Lane, West Melbourne, FL 32904 | 2017-10-20 |
| 1598205221 | Marathon Health, LLC | General Practice | 2550 Wingate Boulevard, C/o Brevard Wellcare- South, West Melbourne, FL 32904 | 2017-02-28 |
| 1366875387 | Cancer Center of Melbourne LLC | Clinic/Center | 415 S. Wickham Rd., Melbourne, FL 32904 | 2013-08-13 |
| 1558704312 | Sandra Suzanne Borthwick | Social Worker | 569 Sylvia Rd, Melbourne, FL 32904 | 2013-04-11 |
| 1396983607 | Genesis | Skilled Nursing Facility | 2653 Reflections Pl, W. Melbourne, FL 32904 | 2009-01-23 |
| Find all providers in zip 32904 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447322615 | Baba Healthcare, Inc. | Internal Medicine | 964 S Wickham Rd, Suite 1, West Melbourne, FL 32904-1460 | 2006-11-14 |
| 1942311964 | Joseph W Slattery IIi | Internal Medicine | 630 S Wickham Rd, West Melbourne, FL 32904-1428 | 2006-08-31 |
| 1871539072 | Aravind K Kumar | Internal Medicine | 2795 W New Haven Ave, West Melbourne, FL 32904-3705 | 2006-06-22 |
| 1538563754 | Sunflower Concierge Medical Services LLC | Internal Medicine | 948 S Wickham Rd, Ste 101, West Melbourne, FL 32904-1647 | 2014-10-17 |
| 1578873709 | Joseph W Slattery IIi Md Pa | Internal Medicine | 630 S Wickham Rd, Suite 101, West Melbourne, FL 32904-1428 | 2010-10-21 |
| 1639241862 | Geetha Priyanka | Internal Medicine | 948 S Wickham Rd, Suite 103, West Melbourne, FL 32904-1647 | 2006-11-14 |
| 1811071582 | R & R Internal Medicine Services Pa | Internal Medicine | 1541 S Wickham Rd, West Melbourne, FL 32904-3540 | 2006-10-25 |
| 1376505834 | George Roque | Internal Medicine | 1541 S Wickham Rd, West Melbourne, FL 32904-3540 | 2006-04-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821699034 | Sia - Specialty Infusion LLC | Internal Medicine | 2200 Glades Rd Ste 304, Boca Raton, FL 33431-7348 | 2020-11-04 |
| 1255932703 | Cape Coral Integrated Medical | Internal Medicine | 643 Cape Coral Pkwy E Ste E, Cape Coral, FL 33904-8549 | 2020-11-02 |
| 1497355887 | Orange Care Physician Partners of Florida, LLC | Internal Medicine | 14750 Nw 77th Ct Ste 308, Miami Lakes, FL 33016-1537 | 2020-10-27 |
| 1811596562 | Shari Rosenbaum Md Pllc | Internal Medicine | 1905 Clint Moore Rd Ste 204, Boca Raton, FL 33496-2660 | 2020-10-23 |
| 1801495585 | United Teledoc Inc | Internal Medicine | 231 Del Prado Blvd S, Cape Coral, FL 33990-5707 | 2020-10-22 |
| 1467051896 | Jermaine Campbell Do, LLC | Internal Medicine | 2701 N Course Dr Apt 125, Pompano Beach, FL 33069-3030 | 2020-10-16 |
| 1245838150 | Neighbormd of Tamarac LLC | Internal Medicine | 7646 N Nob Hill Rd, Tamarac, FL 33321-1869 | 2020-10-13 |
| 1841898756 | Neighbormd of Miami Beach LLC | Internal Medicine | 4302 Alton Rd Ste 320, Miami Beach, FL 33140-2818 | 2020-10-13 |
| 1437757358 | Neighbormd of Palm Beach Gardens | Internal Medicine | 3345 Burns Rd Ste 204&205, Palm Beach Gardens, FL 33410-4324 | 2020-10-13 |
| 1306444211 | Neighbormd of Aventura LLC | Internal Medicine | 2845 Aventura Blvd Ste 240, Aventura, FL 33180-3120 | 2020-10-13 |
| Find all providers with the same taxonomy | ||||
| City | WEST MELBOURNE |
| Zip Code | 32904 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.