INDIAN RIVER MEDICAL OFFICE PA (NPI# 1245220557) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245220557 |
| Entity Type | Organization |
| Organization Name | INDIAN RIVER MEDICAL OFFICE PA |
| Practice Address |
3300 Dairy Rd Titusville FL 32796-1512 |
| Practice Telephone | 3212696530 |
| Practice Fax Number | 3212692334 |
| Mailing Telephone | 3212696530 |
| Mailing Fax Number | 3212692334 |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2011-03-03 |
| Authorized Official Name | JILL D WHITTAMORE (ADMINISTRATOR) |
| Authorized Official Telephone | 3212676687 |
| Authorized Official Credential | CMM CPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS FL | 40745 | 01 |
| FL | 250742100 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467840710 | Indian River Medical Office Pa | Nurse Practitioner | 3300 Dairy Rd, Titusville, FL 32796-1512 | 2015-01-08 |
| Street Address |
3300 DAIRY RD |
| City | TITUSVILLE |
| State | FL |
| Zip Code | 32796-1512 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912900325 | Imran Rashid | Specialist | 3300 Dairy Rd, Titusville, FL 32796-1512 | 2005-05-31 |
| 1619323441 | Josephine Health LLC | Psychiatry & Neurology | 3300 Dairy Rd, Titusville, FL 32796-1512 | 2016-05-11 |
| 1073903639 | Debra Allen | Nurse Practitioner | 3300 Dairy Rd, Titusville, FL 32796-1512 | 2015-02-03 |
| 1467840710 | Indian River Medical Office Pa | Nurse Practitioner | 3300 Dairy Rd, Titusville, FL 32796-1512 | 2015-01-08 |
| 1396172409 | Jacklyn Alexis Xavier | Physician Assistant | 3300 Dairy Rd, Titusville, FL 32796-1512 | 2013-10-03 |
| 1649564642 | Kimberly Evangelista Lundquist | Nurse Practitioner | 3300 Dairy Rd, Indian River Medical Office Pa, Titusville, FL 32796-1512 | 2011-06-07 |
| 1467769612 | Sherry Lynn Riley | Nurse Practitioner | 3300 Dairy Rd, Titusville, FL 32796-1512 | 2010-09-09 |
| 1467586388 | Cheryl M Gardner | Nurse Practitioner | 3300 Dairy Rd, Titusville, FL 32796-1512 | 2007-03-15 |
| 1215939509 | Aluino Lawrence Ochoa | Specialist | 3300 Dairy Rd, Titusville, FL 32796-1512 | 2005-06-01 |
| 1750384160 | Karin Ann Ochoa | Specialist | 3300 Dairy Rd, Titusville, FL 32796 | 2005-05-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427698091 | Miranda Jade Lacey | Behavior Technician | 2073 Graden St, Titusville, FL 32796 | 2020-01-13 |
| 1588183818 | Charles Hopkins Jr. | Behavior Technician | 2073 Garden St., Titusville, FL 32796 | 2017-09-19 |
| 1962924456 | Robin Marie Ahlgren | Social Worker | 503 South Palm Ave, Titusville, FL 32796 | 2017-07-17 |
| 1669994158 | New Creation Counseling | Social Worker | 503 South Palm Ave., Titusville, FL 32796 | 2017-07-17 |
| 1255719506 | Daniel Joseph Spagnoli | Dentist | 55 N Carpenter Rd, Titusville, FL 32796 | 2015-05-07 |
| 1033511415 | Imran Rashid Md Pa | Internal Medicine | 3300 Dairy Road, Titusville, FL 32796 | 2014-09-17 |
| 1639425432 | William Henry Ruppert Jr. | Dietitian, Registered | 2191 Garden Street, Titusville, FL 32796 | 2012-07-30 |
| 1437410230 | Betsy Cooduvalli | Dermatology | 500 N Washington Ave Ste 109, Titusville, FL 32796 | 2012-06-07 |
| 1134403108 | Titusville Chiropractic & Injury Center, Inc. | Chiropractor | 850 Century Medical Drive, Titusville, FL 32796 | 2011-10-07 |
| 1992095152 | Jennifer Eleanor Koffman | Occupational Therapy Assistant | 140 N Hilltop Drive, Titusville, FL 32796 | 2011-04-08 |
| Find all providers in zip 32796 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598169922 | Kelli Mcdonel | Specialist | 3954 Ridgewood Dr, Titusville, FL 32796-2251 | 2014-10-14 |
| 1104199348 | Rebecca E Covert | Specialist | 3910 S Washington Ave Ste 109, Titusville, FL 32780-5860 | 2012-02-20 |
| 1497943732 | Gail Linebaugh Ratliff | Specialist | 2615 Baywood Dr, Titusville, FL 32780-5903 | 2007-10-11 |
| 1710105267 | Jeanette Van Duyne | Specialist | 5650 S Washington Ave, Titusville, FL 32780-7312 | 2007-04-22 |
| 1639204019 | Justo Gonzalez | Specialist | 2203 Garden St, Titusville, FL 32796-2577 | 2007-02-23 |
| 1760567820 | Anesthesia Associates of Titusvlle | Specialist | 1504 Garden St, Titusville, FL 32796-3268 | 2006-10-26 |
| 1073585741 | 'young C Fan Md' | Specialist | 119 E Mechanic St, Titusville, PA 16354-2161 | 2006-02-06 |
| 1962482349 | Sachin R Shenoy | Specialist | 1845 Jess Parrish Ct, Titusville, FL 32796-2123 | 2006-01-20 |
| 1346248242 | Ronald Christopher Ryan | Specialist | 1917 Knox Mcrae Dr, Titusville, FL 32780-5360 | 2005-07-13 |
| 1306841473 | Mark R Licht | Specialist | 825 Century Medical Dr, Titusville, FL 32796-2113 | 2005-06-16 |
| Find all providers in TITUSVILLE | ||||
| City | TITUSVILLE |
| Zip Code | 32796 |
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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.