NPIMap

Organization Active NPI

Memorial Health Systems Inc

Doing business as AdventHealth Daytona Beach

  • Clinical Medical Laboratory
  • Daytona Beach, FL
National Provider Identifier
1104696178
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MEMORIAL HEALTH SYSTEMS INC
Doing business as
AdventHealth Daytona Beach
Practice address
301 Memorial Medical Pkwy
Daytona Beach, FL 32117-5167
Phone
(386) 231-6000
NPI assigned
Jan 2, 2024
Last updated
Jan 8, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL HEALTH SYSTEMS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Authorized official

Name
Cory Douglas Domayer
Title
Cfo
Phone
(386) 586-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

301 Memorial Medical Pkwy
Daytona Beach, FL 32117-5167

Mailing address

770 W Granada Blvd Ste 203
Ormond Beach, FL 32174-5179

Other names 1

  • AdventHealth Daytona Beach Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com/ Other

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040131000349 FL Part A Provider - Hospital 9739081142 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Daytona Beach, FL; Port Orange, FL; Palm Coast, FL; Ormond Beach, FL; New Smyrna Beach, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104696178. Details of each certification follow.

Hospital certification: CCN 100068

Legal name
MEMORIAL HEALTH SYSTEMS INC
Doing business as
ADVENTHEALTH DAYTONA BEACH
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 6, 1993
Beds
362
Ownership / control type
Church
Most recent change of ownership
Nov 11, 1999 (5 total)
Organization structure
CorporationNon-profit
Incorporated
Aug 18, 1961 in FL
Enrollment address
301 Memorial Medical Pkwy
Daytona Beach, FL 32117-5167
Hospital subgroups
General, Acute care, Rehabilitation unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Adventhealth Daytona BeachCCN 100068 · All quality measures
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
10D0665348Adventhealth Lab301 Memorial Medical Pkwy, Daytona Beach, FL 32117AccreditationFeb 27, 2027
10D2009123Adventhealth Lab301 Memorial Medical Pkwy, Daytona Beach, FL 32117Certificate of waiverJun 24, 2028

National Provider Directory

National Provider Directory
Tax ID family
Ear Nose Throat Assoc11 organizations share this tax ID, including this one
Part of
Ear Nose Throat Assoc

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations (25 of 31)

103 Memorial Medical Pkwy
Ste 100
Daytona Beach, FL 32117
Phone (386) 231-3690

103 Memorial Medical Pkwy
Ste 225
Daytona Beach, FL 32117
Phone (386) 231-8820

305 Memorial Medical Pkwy
Ste 100
Daytona Beach, FL 32117
Phone (386) 231-6038

305 Memorial Medical Pkwy
Ste 203
Daytona Beach, FL 32117
Phone (386) 231-3512

305 Memorial Medical Pkwy
Ste 307
Daytona Beach, FL 32117
Phone (386) 231-3512

305 Memorial Medical Pkwy
Ste 401
Daytona Beach, FL 32117
Phone (386) 231-3540

1070 N Stone St
Ste E
Deland, FL 32720
Phone (386) 738-5300

125 Florida Memorial Pkwy
Ste 103
New Smyrna Beach, FL 32168
Phone (386) 409-6800

290 Clyde Morris Blvd
Ste A2
Ormond Beach, FL 32174
Phone (386) 231-3490

305 Clyde Morris Blvd
Ste 130
Ormond Beach, FL 32174
Phone (386) 231-6280

355 Clyde Morris Blvd
Ste 240
Ormond Beach, FL 32174

55 N Old Kings Rd
Ormond Beach, FL 32174
Phone (386) 677-4180

770 W Granada Blvd
Ste 203
Ormond Beach, FL 32174
Phone (386) 231-4252

770 W Granada Blvd
Ste 204
Ormond Beach, FL 32174
Phone (386) 671-4500

873 Sterthaus Dr
#206A
Ormond Beach, FL 32174
Phone (386) 673-8588

873 Sterthaus Dr
#212
Ormond Beach, FL 32174
Phone (386) 676-6402

873 Sterthaus Dr
#301
Ormond Beach, FL 32174
Phone (386) 676-6172

873 Sterthaus Dr
#303
Ormond Beach, FL 32174
Phone (386) 671-6591

873 Sterthaus Dr
#305
Ormond Beach, FL 32174
Phone (386) 671-6542

873 Sterthaus Dr
Ste 212
Ormond Beach, FL 32174
Phone (386) 676-6402

873 Sterthaus Dr
Ste 301
Ormond Beach, FL 32174
Phone (386) 672-3320

26 Office Park Dr
#B
Palm Coast, FL 32137
Phone (386) 446-9966

60 Memorial Medical Pkwy
#1700
Palm Coast, FL 32164
Phone (386) 586-1860

61 Memorial Medical Pkwy
Ste 3187
Palm Coast, FL 32164
Phone (386) 586-1730

61 Memorial Medical Pkwy
Ste 3802
Palm Coast, FL 32164
Phone (386) 437-2481

Ownership & related parties

All disclosed owners & managing parties 34

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ketul R Patel Individual Corporate DirectorDirector Jan 1, 2023
Debora H Thomas Individual Corporate OfficerAssistant Secretary Aug 24, 2023
Corporate DirectorDirector Aug 24, 2023
Philip Maroney Individual Corporate DirectorDirector Sep 17, 2020
Douglas Hilliard Individual Corporate OfficerAsst Secretary Aug 21, 2025
John J Adams Individual Corporate DirectorDirector Feb 21, 2013
Gloria Ceballos Individual Corporate DirectorDirector Aug 17, 2023
Jeffrey Graff Individual Corporate OfficerAssistant Secretary Sep 11, 2014
Meetesh S Desai Individual Corporate DirectorDirector Feb 18, 2021
Diane Godfrey Individual Corporate OfficerAsst Secretary Dec 11, 2025
Robert Deininger Individual Corporate OfficerAsst Secretary, Chair Jun 13, 2025
Corporate DirectorDirector Jun 13, 2025
Andrea Hooper Individual Corporate DirectorDirector Aug 24, 2023
Michael Saunders Individual Corporate OfficerAssistant Secretary Feb 22, 2007
Paul C Rathbun Individual Corporate OfficerAssistant Secretary Sep 11, 2014
David a Burt Individual Corporate DirectorDirector Jan 1, 2009
Dennis a Hernandez Individual Corporate DirectorDirector Apr 28, 2022
David a Weis Individual Corporate OfficerPresident Aug 28, 2022
Francis Owens Individual Contracted Managing Employee Feb 15, 2026
Corporate OfficerCfo Feb 15, 2026
Operational/Managerial ControlCfo Feb 15, 2026
Adventist Health System Sunbelt Healthcare Corporation Organization, Altamonte Springs, FL Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Oct 1, 2000 100%
Amanda Brady Individual Corporate OfficerAssistant Secretary Feb 27, 2020
Toni Berrios Individual Corporate OfficerAssistant Secretary Aug 25, 2022
Haney Vincent Individual Corporate OfficerAssistant Secretary Dec 9, 2021
Nika Hosseini Individual Corporate DirectorDirector Apr 4, 2024
James Arocho Individual Corporate DirectorDirector Sep 11, 2014
Todd a Goodman Individual Corporate OfficerAsst Secretary, Vice Chairperson Sep 14, 2017
Corporate DirectorDirector Feb 23, 2017
David R Sinclair Individual Contracted Managing EmployeeCeo Mar 9, 2025
Corporate OfficerCeo Mar 9, 2025
Operational/Managerial ControlCeo Mar 9, 2025
David L Huffman Individual Corporate OfficerAssistant Secretary Feb 27, 2020
Julie L Turpin Individual Corporate DirectorDirector Aug 21, 2025
Robert C Foltz Individual Corporate OfficerAssistant Secretary Sep 11, 2014
Lynn Addiscott Individual Corporate OfficerAssistant Secretary Feb 5, 2002
Randall Haffner Individual Corporate DirectorDirector Apr 8, 2021
Utpal Sureskumar Desai Individual Corporate DirectorDirector Jan 1, 2025
John P Ferguson Individual Corporate DirectorDirector Jun 8, 2017
Beverly Morgan Individual Corporate OfficerAsst Secretary Aug 21, 2025
Adventist Health System Sunbelt Inc Organization, Altamonte Springs, FL Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 1, 2000 100%

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 19

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 19

Affiliated clinicians 1,400

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,400

NPI Registry JSON

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

{
    "created_epoch": "1704153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1104696178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 W GRANADA BLVD STE 203",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321745179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MEMORIAL MEDICAL PKWY",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175167",
            "telephone_number": "386-231-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HEALTH SYSTEMS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL HEALTH SYSTEMS INC",
        "enumeration_date": "2024-01-02",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "DOMAYER",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "386-586-4200"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "AdventHealth Daytona Beach",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AdventHealth Daytona Beach",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.