NPIMap

Organization Active NPI

Emerald Coast Infectious Diseases Medical Group, PA

  • Community/Retail Pharmacy
  • Fort Walton Beach, FL
National Provider Identifier
1154773950
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP, PA
Practice address
917 Mar Walt Drive
Suite D
Fort Walton Beach, FL 32547
Phone
(850) 312-3570
Fax
(850) 312-3090
NPI assigned
Jul 6, 2016
Organization subpart
Yes
Parent organization
EMERALD COAST INFECTIOUS DISEASESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Authorized official

Name
Mr. Eric Squatrito
Title
Vice President of Operations
Phone
(724) 977-8498

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PH30219 FL
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

917 Mar Walt Drive
Suite D
Fort Walton Beach, FL 32547

Mailing address

1620 W. Northwest Hwy
Suite 100
Grapevine, TX 76051
Phone (817) 572-0009

Other identifiers 2

IdentifierTypeStateIssuer
1165528300MedicaidFL
2160919OtherPK

Other names 1

  • Synergy Specialty Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Emerald Coast Infectious Diseases Medical Group PA7 organizations share this tax ID, including this one
Part of
Emerald Coast Infectious Diseases Medical Group PA

Other organizations with this tax ID 6

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

137 Crystal Beach Dr
Ste 121
Destin, FL 32541
Phone (850) 424-7320

917 Mar Walt Dr
Ste D
Fort Walton Beach, FL 32547
Phone (850) 312-3570

917 Mar Walt Dr
Ste C
Fort Walton Beach, FL 32547
Phone (850) 312-3570

1710 Lisenby Ave
Panama City, FL 32405
Phone (850) 248-7284

Practitioners & affiliated clinicians

Practitioners 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740960000000",
    "number": "1154773950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 W. NORTHWEST HWY",
            "address_2": "SUITE 100",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "76051",
            "telephone_number": "817-572-0009",
            "fax_number": "817-572-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 MAR WALT DRIVE",
            "address_2": "SUITE D",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "32547",
            "telephone_number": "850-312-3570",
            "fax_number": "850-312-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMERALD COAST INFECTIOUS DISEASES",
        "enumeration_date": "2016-07-06",
        "last_updated": "2025-03-03",
        "certification_date": "2025-02-27",
        "status": "A",
        "authorized_official_last_name": "SQUATRITO",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "724-977-8498",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "FL",
            "license": "PH30219",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1165528300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160919",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Synergy Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Synergy Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.