Medical Center of Deltona, Inc.
Organization Active NPI General Acute Care Hospital · Deltona, FL
NPI 1003465097 · NPPES record last updated Jun 22, 2020
Key facts
- NPI
- 1003465097
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- Legal business name
- MEDICAL CENTER OF DELTONA, INC.
- Practice address
- 3300 Halifax Crossings Blvd.
Deltona, FL 32725 - Phone
- (386) 254-4000
- NPI assigned
- Sep 11, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- HALIFAX HOSPITAL MEDICAL CENTER
Authorized official
- Name
- Eric M Peburn
- Title
- Cfo
- Phone
- (386) 425-4568
Owners & managing parties with NPI records 1
Member of 1
Facilities with the same owner 3
Affiliated clinicians 151
-
John Edward Agles, M.D.
-
Kristen Nicole Baker, M.D.
-
Christine Spires Barry, ARNP
-
Amanullah Bilal, MD
-
Amber Jo Bryant, ARNP
-
Amanda Burleson, APRN
-
Jorge Luis Cambo, MD
-
Francisco J Camino, M.D.
-
Cari Candas, MD
-
Rulz T. Cantave, M.D.
-
Boon Yee Chew, MD
Medicare Care Compare: Hospital
- Listed as
- Halifax Health /Uf Health Medical Center of Delton
- Type
- Acute Care Hospitals
- Ownership
- Government - Local
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2123667 | Medical Center of Deltona, Inc | Accreditation | May 29, 2028 |
| 10D2174989 | Medical Center of Deltona | Accreditation | Aug 11, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Hospital certification: CCN 100330
- Legal name
- MEDICAL CENTER OF DELTONA, INC.
- Doing business as
- HALIFAX HEALTH UF HEALTH MEDICAL CENTER OF DELTONA
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Mar 12, 2020
- Last certification
- Sep 17, 2020
- Beds
- 42
- Ownership / control type
- Local
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 18, 2019 in FL
- Enrollment address
- 3300 Halifax Crossings Blvd
Deltona, FL 32725-2911 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Jeffrey Feasel |
Corporate Officer |
Jul 18, 2019 | |
| Corporate Director |
Sep 9, 2019 | ||
| Operational/Managerial Control |
Jul 18, 2019 | ||
| Andrea Kurak |
Corporate Director |
Sep 9, 2019 | |
| Halifax Hospital Medical Center |
5% Or Greater Direct Ownership Interest | Jul 18, 2019 | |
| Operational/Managerial Control | Dec 10, 2019 | 50% | |
| Shawn Remington |
Corporate Officer |
Dec 18, 2023 | |
| W-2 Managing Employee |
Dec 18, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191016001487 | FL | Part a Provider - Hospital | 0446581813 | Practice locations: Deltona, FL |
National Provider Directory
- Part of
- Halifax Hospital Medical Center
Locations
3400 E Halifax Crossing Blvd
Ste 120
Deltona, FL 32725
3300 E Halifax Crossing Blvd
Deltona, FL 32725
Phone (386) 425-1800
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | Yes |
Addresses
Primary practice location
3300 Halifax Crossings Blvd.
Deltona, FL 32725
Mailing address
303 N Clyde Morris Blvd
Daytona Beach, FL 32114-2700
Phone (386) 254-4000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NJC | Other | FL | BLUE CROSS |
| 105531100 | Medicaid | FL | |
| 10-0330 | Other | FL | MEDICARE/OSCAR CERTIFICATION |
Other names
- Halifax Health UF Health - Medical Center of Deltona
Other providers in Deltona, FL
- Shiairren McQueen
- MDSS Services LLC
- MDSS Services LLC
- Aaliyah Meadows
- Maria Cecilia Meaux
- Medical Fits LLC
- Medical Hopper
- Medical Lab on Wheels Inc
- Jayesh Mehta
- Katie Meier
All providers in Deltona, FL · General Acute Care Hospital in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.