Op Medical LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

ME0067232 Issued in FL

Legal business name

OP MEDICAL LLC

Practice address

1515 Herbert St
Ste 209
Port Orange, FL 32129-6104

Phone

(386) 366-9119

NPI assigned

Aug 19, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Andrew Joseph Ottaviani

Title

Clinic Director

Phone

(386) 366-9119

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

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

{
    "created_epoch": "1250640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250640000000",
    "number": "1144452582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 HERBERT ST",
            "address_2": "STE 209",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321296104",
            "telephone_number": "386-366-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 HERBERT ST",
            "address_2": "STE 209",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321296104",
            "telephone_number": "386-366-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OP MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-19",
        "last_updated": "2009-08-19",
        "status": "A",
        "authorized_official_last_name": "OTTAVIANI",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "386-366-9119",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "FL",
            "license": "ME0067232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kirstin Olstad
• Tinuade Olusegun, M.D.
• Anthony Aden Ombogo, M.D.
• On-Call Medical Supplies, LLC
• Anuliudochi Onyemaechi
• Options Home Health of North Florida, Inc.
• Orlando Vamc
• Ormond Radiology Partnership, L.L.C
• Julianna Orozco
• Jacqueline Orr

• Interventional Pain Medicine Physician in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Interventional Pain Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2009; 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.