Atlantic Medical Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME88828 Issued in FL

Legal business name

ATLANTIC MEDICAL GROUP

Practice address

1541 S Wickham Rd
West Melbourne, FL 32904-3540

Phone

(321) 726-6331

Fax

(321) 726-6371

NPI assigned

Mar 29, 2006

Organization subpart

No

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

Authorized official

Name

Dr. George Roque, M.D.NPI 1376505834

Title

President

Phone

(321) 726-6331

Specialties & licenses 1

Addresses

Other identifiers 11

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2460/brand/1/csg/1/fhir/r4

Practitioners 7

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

• George Roque, M.D.

  • Internal Medicine Physician
  • West Melbourne, FL
  • NPI 1376505834
  Medicare reassignment NPD Authorized official
• Elizabeth Marie Ambrose

  • Nurse Practitioner
  • Melbourne, FL
  • NPI 1043509300
  Medicare reassignment
• Luis Cantor

  • Medical Physician Assistant
  • Melbourne, FL
  • NPI 1295353670
  Medicare reassignment
• Ann-Marie Holness, PA-C

  • Physician Assistant
  • Melbourne, FL
  • NPI 1902447071
  Medicare reassignment
• April Elaine Mela, PA-C

  • Medical Physician Assistant
  • Melbourne, FL
  • NPI 1215274808
  Medicare reassignment
• Arlene Michel, PA-C

  • Internal Medicine Physician
  • Fort Lauderdale, FL
  • NPI 1760919781
  Medicare reassignment
• Daniel Vega, PA-C

  • Medical Physician Assistant
  • West Melbourne, FL
  • NPI 1003522921
  Medicare reassignment

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144281247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 S WICKHAM RD",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329043540",
            "telephone_number": "321-726-6331",
            "fax_number": "321-726-6371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 S WICKHAM RD",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329043540",
            "telephone_number": "321-726-6331",
            "fax_number": "321-726-6371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROQUE",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-726-6331",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME88828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE PROVIDER #",
            "identifier": "159351XX",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID",
            "identifier": "37972",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH PROVIDER NO.",
            "identifier": "1809978",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PROVIDER NO.",
            "identifier": "9303692",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCARE GROUP #",
            "identifier": "DD4702",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCARE PROVIDER #",
            "identifier": "P00022983",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE MCAID PROVIDER #",
            "identifier": "246370",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN NETWORK PROVIDER NO.",
            "identifier": "5585831",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NO.",
            "identifier": "7274610",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDIANCARE PROVIDER #",
            "identifier": "10024",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS PROVIDER #",
            "identifier": "9362860",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maria Julia Aragona
• Tyler Wayne Armstrong
• Siddharth Singh Arora, D.O., M.S.
• Michele L Arsenault
• Makail Arshad
• Autism Center for Development and Behavior
• Paige Avchen
• Avia Total Health PLLC
• Makayla L Ayers
• Baba Healthcare, Inc.

• Internal Medicine Physician in West Melbourne, FL
• Providers in West Melbourne, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.