NPIMap

Organization Active NPI

HN Ucc LLC

Doing business as Halifax Health Express Care

  • Urgent Care Clinic/Center
  • Daytona Beach, FL
National Provider Identifier
1093308504
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
HN UCC LLC
Doing business as
Halifax Health Express Care
Practice address
3048 S Atlantic Ave
Daytona Beach, FL 32118-6102
Phone
(423) 531-1330
NPI assigned
Feb 16, 2021
Last updated
Apr 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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

Authorized official

Name
Katherine Elizabeth Pendergrass
Title
Director of Revenue Cycle
Phone
(423) 331-2055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

3048 S Atlantic Ave
Daytona Beach, FL 32118-6102

Mailing address

3048 S Atlantic Ave
Daytona Beach, FL 32118-6102

Other practice location 1

1688 W Granada Blvd Ste 1C
Ormond Beach, FL 32174-1818
Phone (423) 531-1330

Other practice location 2

2090 Saxon Blvd
Deltona, FL 32725-3251
Phone (423) 531-1330

Other practice location 3

5440 S Williamson Blvd
Port Orange, FL 32128
Phone (423) 531-1330

Other names 1

  • Halifax Health Express Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210831002196 FL Part B Supplier - Clinic/Group Practice 8426454489 Receives reassigned benefits from 25 practitioners
Practice locations: Daytona Beach, FL; Deltona, FL; Ormond Beach, FL; Port Orange, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2230698HN Ucc LLC D/a Halifax Health Express Care3048 S Atlantic Ave Ste 101, Daytona Beach, FL 32118Certificate of waiverJul 26, 2027
10D2231985HN Ucc LLC D/a Halifax Health Express Care2090 Saxon Blvd, Deltona, FL 32725Certificate of waiverAug 8, 2027
10D2241382HN Ucc LLC D/a Halifax Health Expresscare5440 S Williamson Blvd, PT Orange, FL 32128Certificate of waiverOct 26, 2027

National Provider Directory

National Provider Directory

Locations

1688 W Granada Blvd
Ste 1C
Ormond Beach, FL 32174
Phone (386) 845-5453

775 W Granada Blvd
Ste 102
Ormond Beach, FL 32174
Phone (386) 425-4480

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1613433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1093308504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3048 S ATLANTIC AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321186102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3048 S ATLANTIC AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321186102",
            "telephone_number": "423-531-1330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1688 W Granada Blvd Ste 1C",
            "address_purpose": "LOCATION",
            "city": "Ormond Beach",
            "state": "FL",
            "postal_code": "321741818",
            "country_code": "US",
            "telephone_number": "423-531-1330",
            "fax_number": "386-845-5457",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2090 Saxon Blvd",
            "address_purpose": "LOCATION",
            "city": "Deltona",
            "state": "FL",
            "postal_code": "327253251",
            "country_code": "US",
            "telephone_number": "423-531-1330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5440 S Williamson Blvd",
            "address_purpose": "LOCATION",
            "city": "Port Orange",
            "state": "FL",
            "postal_code": "32128",
            "country_code": "US",
            "telephone_number": "423-531-1330",
            "fax_number": "386-845-5455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HN UCC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-16",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "PENDERGRASS",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "423-331-2055"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Halifax Health Express Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Halifax Health Express Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.