NPIMap

Organization Active NPI

Conviva Medical Center Management LLC

Doing business as Conviva Fort Pierce

  • Internal Medicine Physician
  • Fort Pierce, FL
National Provider Identifier
1104688548
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CONVIVA MEDICAL CENTER MANAGEMENT LLC
Doing business as
Conviva Fort Pierce
Practice address
1215 S 25TH St
Fort Pierce, FL 34947-4702
Phone
(772) 837-6918
NPI assigned
Jan 30, 2024
Last updated
May 20, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CONVIVA MEDICAL CENTER MANAGEMENT LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Authorized official

Name
Kevin Meriwether
Title
President
Phone
(305) 500-2000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
General Practice Physician 208D00000X NU

Addresses

Primary practice location

1215 S 25TH St
Fort Pierce, FL 34947-4702

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000

Other names 1

  • Conviva Fort Pierce Doing business as

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
10D2217097Conviva Medical Center Management, LLC1215 S 25TH St, Fort Pierce, FL 34947Certificate of waiverMar 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Conviva Med Ctr MGMT LLC76 organizations share this tax ID, including this one
Part of
Conviva Med Ctr MGMT LLC

Organizations with this tax ID in the same state 17

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

View all 17

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1706572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716163200000",
    "number": "1104688548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 S 25TH ST",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349474702",
            "telephone_number": "772-837-6918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVIVA MEDICAL CENTER MANAGEMENT LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONVIVA MEDICAL CENTER MANAGEMENT LLC",
        "enumeration_date": "2024-01-30",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A",
        "authorized_official_last_name": "MERIWETHER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-500-2000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conviva Fort Pierce",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Conviva Fort Pierce",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Pierce, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.