NPIMap

Organization Active NPI

Treasure Coast Palliative Care, LLC

  • Specialist
  • Stuart, FL
National Provider Identifier
1063658086
Registry record updated Apr 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
TREASURE COAST PALLIATIVE CARE, LLC
Practice address
1201 SE Indian St
Stuart, FL 34997-5688
Phone
(772) 403-4500
Fax
(772) 781-8031
NPI assigned
Dec 22, 2008
Last updated
Apr 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jackie Kendrick
Title
President & Chief Executive Officer
Phone
(772) 403-4500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

1201 SE Indian St
Stuart, FL 34997-5688

Mailing address

1201 SE Indian St
Stuart, FL 34997-5688
Phone (772) 403-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110330000397 FL Part B Supplier - Clinic/Group Practice 0648453589 Receives reassigned benefits from 12 practitioners
Practice locations: Fort Pierce, FL

National Provider Directory

National Provider Directory

Locations

5000 NW Dunn Rd
Fort Pierce, FL 34981
Phone (772) 403-4500

1201 SE Indian St
Stuart, FL 34997
Phone (772) 403-4500

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650844800000",
    "number": "1063658086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 SE INDIAN ST",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349975688",
            "telephone_number": "772-403-4500",
            "fax_number": "772-781-8031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SE INDIAN ST",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349975688",
            "telephone_number": "772-403-4500",
            "fax_number": "772-781-8031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TREASURE COAST PALLIATIVE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-22",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A",
        "authorized_official_last_name": "KENDRICK",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "772-403-4500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stuart, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.