SPINE INSTITUTE ON THE EMERALD COAST (NPI# 1184235558) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184235558 |
| Entity Type | Organization |
| Organization Name | SPINE INSTITUTE ON THE EMERALD COAST |
| Practice Address |
350g Racetrack Rd Nw Fort Walton Beach FL 32547-1699 |
| Mailing Address |
155 Crystal Beach Dr Ste 200 Destin FL 32541-3588 |
| Practice Telephone | 8504602350 |
| Practice Fax Number | 8664901517 |
| Mailing Telephone | 8504602350 |
| Mailing Fax Number | 8664901517 |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2020-08-11 |
| Authorized Official Name | AMRISH PATEL (CHIEF MEDICAL OFFICER, OWNER) |
| Authorized Official Telephone | 8504602350 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Coastal Neurosurgery & Spine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336400704 | Spine Institute On The Emerald Coast | Orthopaedic Surgery | 155 Crystal Beach Dr Ste 200, Destin, FL 32541-3588 | 2012-06-01 |
| Street Address |
350G RACETRACK RD NW |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-1699 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952487241 | Timothy R. Monroe | Neurological Surgery | 350g Racetrack Rd Nw, Fort Walton Beach, FL 32547-1699 | 2006-10-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| Taxonomy Code | 207XS0117X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Orthopaedic Surgery of the Spine |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386293215 | Citrus Spine Institute LLC | Orthopaedic Surgery | 1409 Kingsley Ave Ste 9f, Orange Park, FL 32073-4579 | 2019-09-04 |
| 1194383638 | Ortho Florida, LLC | Orthopaedic Surgery | 8190 S Jog Rd Ste 101, Boynton Beach, FL 33472-2911 | 2019-05-30 |
| 1821571175 | Orthopedic Spine Solutions Corp | Orthopaedic Surgery | 3852 Sheridan St, Hollywood, FL 33021-3634 | 2018-09-12 |
| 1194223461 | Select Health of Fl, LLC | Orthopaedic Surgery | 2 S Biscayne Blvd Ste 3760a, Miami, FL 33131-1815 | 2018-01-31 |
| 1568960839 | Spine Cin of Jacksonville LLC | Orthopaedic Surgery | 1301 Riverplace Blvd Ste 800a, Jacksonville, FL 32207-9047 | 2018-01-31 |
| 1912405283 | Spine Cin of Naples LLC | Orthopaedic Surgery | 8831 Business Park Dr Ste 301a, Fort Myers, FL 33912-2510 | 2018-01-31 |
| 1386142644 | Joint Replacement Cin of Naples LLC | Orthopaedic Surgery | 8831 Business Park Dr Ste 301b, Fort Myers, FL 33912-2510 | 2018-01-31 |
| 1366940140 | Joint Replacement Cin of Orlando LLC | Orthopaedic Surgery | 5401 S Kirkman Rd Ste 310b, Orlando, FL 32819-7940 | 2018-01-26 |
| 1811495690 | Joint Replacement Cin of Miami LLC | Orthopaedic Surgery | 2 S Biscayne Blvd Ste 3760b, Miami, FL 33131-1815 | 2018-01-26 |
| 1689182362 | Fss Keys LLC | Orthopaedic Surgery | 1111 12th St Ste 108, Key West, FL 33040-4087 | 2018-01-17 |
| Find all providers with the same taxonomy | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
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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.