Space Coast Health Centers Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SPACE COAST HEALTH CENTERS INC

Practice address

951 N Washington Ave Ste 100
Titusville, FL 32796-2163

Phone

(386) 852-9565

NPI assigned

Jan 13, 2021

Last updated

Feb 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Arvin Lewis

Title

Ceo

Phone

(321) 268-6836

Specialties & licenses 5

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in FL3 enrollments

Enrollment records 3

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1144819319. Details of each certification follow.

• CCN 691032 Federally qualified health center · Active · Details
• CCN 691033 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 691032

Legal name

SPACE COAST HEALTH CENTERS INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jun 14, 2022

Last certification

Jun 14, 2022

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

May 28, 2020 in FL

Enrollment address

951 N Washington Ave
Ste 100
Titusville, FL 32796-2163

Federally qualified health center certification: CCN 691033

Legal name

SPACE COAST HEALTH CENTERS INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jun 14, 2022

Last certification

Jun 14, 2022

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

May 28, 2020 in FL

Enrollment address

5005 Port St John Pkwy
Ste 2400
Cocoa, FL 32927-4305

Locations

Interoperability endpoints

• Direct secure messaging: arvin.lewis@parrishmed.com
• FHIR API: https://api.platform.athenahealth.com/17832/brand/2/csg/41/fhir/r4

All disclosed owners & managing parties 2

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

Owners & managing parties with NPI records 1

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

• Zackary Philip Besner, MD

  • Internal Medicine Physician
  • Cocoa, FL
  • NPI 1609364728

  Corporate Director, Corporate Officer

  CMS ownership

Practitioners 17

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.

• Zackary Philip Besner, MD

  • Internal Medicine Physician
  • Cocoa, FL
  • NPI 1609364728
  Medicare reassignment Care Compare group NPD
• Johanna B Pillado, APRN, FNP-C

  • Nurse Practitioner
  • Melbourne, FL
  • NPI 1629686415

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Ernesto Rodriguez Valdes, M.D.

  • Family Medicine Physician
  • Miami, FL
  • NPI 1780971754
  Medicare reassignment Care Compare group NPD
• Jason C Wieseler, PSY.D.

  • Counseling Psychologist
  • Melbourne, FL
  • NPI 1528095544
  Medicare reassignment Care Compare group NPD
• Sarah Jeanette Bachmaier, LCSW

  • Clinical Social Worker
  • Rockledge, FL
  • NPI 1851081756
  Medicare reassignment NPD
• Lara Cesar Gabas Molina, MD

  • Obstetrics Physician
  • Orlando, FL
  • NPI 1831715010
  Medicare reassignment NPD
• Theresa Correa, ARNP

  • Family Nurse Practitioner
  • Titusville, FL
  • NPI 1548717838
  Medicare reassignment NPD
• Hannah Haskins

  • Family Nurse Practitioner
  • Cocoa, FL
  • NPI 1891491577
  Medicare reassignment NPD
• Vidya Hate', MD

  • Obstetrics & Gynecology Physician
  • Titusville, FL
  • NPI 1043312945
  Medicare reassignment NPD
• Rahul Lohana, MD

  • Obstetrics & Gynecology Physician
  • Titusville, FL
  • NPI 1124556642
  Medicare reassignment NPD
• Manuel Angel Navas Micheo, M.D., F.A.C.O.G.

  • Obstetrics & Gynecology Physician
  • Titusville, FL
  • NPI 1790733426
  Medicare reassignment NPD
• Judith A. Siron, APRN

  • Advanced Practice Midwife
  • Brandon, FL
  • NPI 1386621019
  Medicare reassignment NPD

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

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707350400000",
    "number": "1144819319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 N WASHINGTON AVE STE 100",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962163",
            "telephone_number": "386-852-9565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 N WASHINGTON AVE STE 100",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962163",
            "telephone_number": "386-852-9565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST HEALTH CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-13",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "ARVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "321-268-6836"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "arvin.lewis@Parrishmed.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "836 Century Medical Dr",
            "city": "Titusville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327962141",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "arvin.lewis@Parrishmed.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "951 N Washington Ave Ste 100",
            "city": "Titusville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327962163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Renee Lok-Yee Wong Soucier, MD
• South Titusville Medical Center Inc
• Southern Living of Titusville
• Sovereign Healthcare of Titusville, LLC (Royal Oaks Nursing & Rehab Center)
• Space Coast Assisted Living LLC
• Space Coast Medical Associates LLP
• Space Coast Medical Center
• Space Coast Medical Consultants PLLC
• Space Coast Ophthalmology LLC
• Space Coast Pain Relief Inc.

• Federally Qualified Health Center (FQHC) in Titusville, FL
• Providers in Titusville, FL by specialty
• Federally Qualified Health Center (FQHC) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.