NPIMap

Organization Active NPI

Advanced Vascular Solutions, LLC

  • Vascular Surgery Physician
  • Sebastian, FL
National Provider Identifier
1104459783
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
ADVANCED VASCULAR SOLUTIONS, LLC
Practice address
13110 US Highway 1
Sebastian, FL 32958-3735
Phone
(772) 581-8900
NPI assigned
Feb 21, 2020
Last updated
Jul 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Authorized official

Name
Jad Shalhoub
Title
External Consultant
Phone
(772) 230-4477

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

13110 US Highway 1
Sebastian, FL 32958-3735

Mailing address

13110 US Highway 1
Sebastian, FL 32958-3735
Phone (772) 581-8900

Other practice location 1

1250 S Harbor City Blvd
Melbourne, FL 32901-3242
Phone (321) 725-8919

Other practice location 2

13100 US Highway 1
Sebastian, FL 32958-3735
Phone (772) 581-8900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200406003299 FL Part B Supplier - Clinic/Group Practice 2567891955 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
Practice locations: Melbourne, FL; Sebastian, FL

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

709 S Harbor City Blvd
Ste 200
Melbourne, FL 32901
Phone (321) 725-8919

Practitioners & affiliated clinicians

Practitioners 10

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": "1582243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753660800000",
    "number": "1104459783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13110 US HIGHWAY 1",
            "city": "SEBASTIAN",
            "state": "FL",
            "postal_code": "329583735",
            "telephone_number": "772-581-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13110 US HIGHWAY 1",
            "city": "SEBASTIAN",
            "state": "FL",
            "postal_code": "329583735",
            "telephone_number": "772-581-8900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1250 S Harbor City Blvd",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329013242",
            "country_code": "US",
            "telephone_number": "321-725-8919",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13100 US Highway 1",
            "address_purpose": "LOCATION",
            "city": "Sebastian",
            "state": "FL",
            "postal_code": "329583735",
            "country_code": "US",
            "telephone_number": "772-581-8900",
            "fax_number": "772-581-4478",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCED VASCULAR SOLUTIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-21",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A",
        "authorized_official_last_name": "SHALHOUB",
        "authorized_official_first_name": "JAD",
        "authorized_official_title_or_position": "EXTERNAL CONSULTANT",
        "authorized_official_telephone_number": "772-230-4477"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sebastian, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; 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.