NPIMap

Organization Active NPI

Steward Medical Group, Inc.

  • Urology Physician
  • Cocoa, FL
National Provider Identifier
1104367630
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
STEWARD MEDICAL GROUP, INC.
Practice address
1317 W Point Dr
Cocoa, FL 32922-6464
Phone
(615) 467-4158
Fax
(615) 467-1267
NPI assigned
Mar 16, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

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

Authorized official

Name
Ashley Koch
Title
Cfo
Phone
(617) 562-5359

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

1317 W Point Dr
Cocoa, FL 32922-6464

Mailing address

9 Galen St
Watertown, MA 02472-4515
Phone (617) 562-5359

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170602001215 FL Part B Supplier - Clinic/Group Practice 2860688728 Receives reassigned benefits from 277 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Compass Medical PC60 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Locations

8000 Ron Beatty Blvd
Ste 3
Barefoot Bay, FL 32976
Phone (772) 581-0334

7970 N Wickham Rd
Ste 101
Melbourne, FL 32940
Phone (321) 637-2150

2222 S Harbor City Blvd
Ste 440
Melbourne, FL 32901
Phone (321) 541-1744

240 N Wickham Rd
Ste 204
Melbourne, FL 32935
Phone (321) 751-1801

240 N Wickham Rd
Ste 309
Melbourne, FL 32935
Phone (321) 308-5084

7970 N Wickham Rd
Ste 102
Melbourne, FL 32940
Phone (321) 255-7711

12920 US Highway 1
Ste A
Sebastian, FL 32958
Phone (772) 228-9808

1600 36th St
Ste C
Vero Beach, FL 32960
Phone (772) 217-4422

Practitioners & affiliated clinicians

Practitioners 178

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 178

NPI Registry JSON

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

{
    "created_epoch": "1489622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597276800000",
    "number": "1104367630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 GALEN ST",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024724515",
            "telephone_number": "617-562-5359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 W POINT DR",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329226464",
            "telephone_number": "615-467-4158",
            "fax_number": "615-467-1267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEWARD MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-16",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A",
        "authorized_official_last_name": "KOCH",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "617-562-5359"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cocoa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; 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.