NPIMap

Individual provider Active NPI

Surya Prakash Rao, MD

  • Cardiovascular Disease Physician
  • Edgewater, FL
National Provider Identifier
1114975596
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
ME96830 Issued in FL
Practice address
1404 S Ridgewood Ave
Edgewater, FL 32132-2720
Phone
(386) 258-8722
Fax
(386) 265-5928
NPI assigned
May 5, 2006
Last updated
Jan 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X ME96830 FL Primary
Nuclear Cardiology Physician 207UN0901X ME96830 FL

Addresses

Primary practice location

1404 S Ridgewood Ave
Edgewater, FL 32132-2720

Mailing address

695 N Clyde Morris Blvd
Daytona Beach, FL 32114-2321
Phone (386) 258-8722

Other practice location 1

780 Dunlawton Ave Ste 101
Port Orange, FL 32127-4252
Phone (386) 265-5926

Other identifiers 2

IdentifierTypeStateIssuer
281152900MedicaidFL
94219OtherFLBC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070208000602 FL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal MedicinePractitioner - Nuclear MedicinePractitioner - Cardiac Surgery 7810946662 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Cardiac Surgery
Education
Loyola University of Chicago, Stritch School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lewis and Klancke Cardiology PAGroup PAC ID 6305731860, 13 clinicians
Florida Hospital Healthcare Partners, IncGroup PAC ID 7012266836, 621 clinicians

Practice addresses (Care Compare)

1404 S Ridgewood Ave
Edgewater, FL 32132-2720
Phone (386) 265-5926

301 Memorial Medical Pkwy
Daytona Beach, FL 32117-5167
Phone (386) 231-6000

630 W Plymouth Ave
Deland, FL 32720-3260
Phone (386) 734-3654

655 N Clyde Morris Blvd
Suite C
Daytona Beach, FL 32114-2321
Phone (386) 258-8722

695 N Clyde Morris Blvd
Daytona Beach, FL 32114-2321

938 Saxon Blvd
Suite 101C
Orange City, FL 32763-8305
Phone (386) 774-5485

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair42
Varicose vein removal11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME96830FLMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Volusia Healthcare Corporation CurrentSince Aug 15, 2018 Accepting new patients
Florida Hospital Healthcare Partners, Inc CurrentSince Dec 1, 2024 Accepting new patients
Florida Cardiovascular Diagnostic Services LLC Cardiovascular Disease Past Accepting new patients
Lewis & Klancke Cardiology, P.a. Cardiovascular Disease PastSince Sep 11, 2022 Accepting new patients
Florida Cardiovascular Association PA Cardiovascular Disease PastSince Dec 16, 2004 Accepting new patients
Volusia ASC BZ, LLC PastSince Jun 16, 2020 Accepting new patients
North Brevard Medical Support, Inc Past Accepting new patients

Locations

301 Memorial Medical Pkwy
Daytona Beach, FL 32117
Phone (386) 231-3906

401 Palmetto St
New Smyrna Beach, FL 32168
Phone (386) 424-5000

508 Palmetto St
New Smyrna Beach, FL 32168
Phone (386) 270-0659

600 Palmetto St
#1
New Smyrna Beach, FL 32168
Phone (386) 424-5000

1055 Saxon Blvd
Orange City, FL 32763
Phone (386) 917-5000

60 Memorial Medical Pkwy
Palm Coast, FL 32164
Phone (385) 586-2000

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1114975596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142321",
            "telephone_number": "386-258-8722",
            "fax_number": "386-258-9443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 S RIDGEWOOD AVE",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "321322720",
            "telephone_number": "386-258-8722",
            "fax_number": "386-265-5928"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "780 Dunlawton Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Port Orange",
            "state": "FL",
            "postal_code": "321274252",
            "country_code": "US",
            "telephone_number": "386-265-5926",
            "fax_number": "386-265-5928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAO",
        "first_name": "SURYA",
        "middle_name": "PRAKASH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME96830",
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "FL",
            "license": "ME96830",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "281152900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "94219",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewater, FL

Sources for this page

Verify at the official NPI Registry.