NPIMap

Organization Active NPI

Home Delivery Incontinent Supplies Co Inc

  • Durable Medical Equipment & Medical Supplies
  • Ormond Beach, FL
National Provider Identifier
1174839617
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
HOME DELIVERY INCONTINENT SUPPLIES CO INC
Practice address
115 E Granada Blvd Ste 6
Ormond Beach, FL 32176-6634
Phone
(800) 367-8360
Fax
(888) 874-4347
NPI assigned
Aug 22, 2010
Organization subpart
Yes
Parent organization
JOURNEY DPC CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

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

Authorized official

Name
Brad Goodwin
Title
President
Phone
(314) 997-8771

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X FL Primary

Addresses

Primary practice location

115 E Granada Blvd Ste 6
Ormond Beach, FL 32176-6634

Mailing address

9385 Dielman Industrial Dr
Olivette, MO 63132-2214
Phone (314) 997-8771

Other identifiers 1

IdentifierTypeStateIssuer
002960300MedicaidFL

Other names 1

  • HDIS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110303000248 FL DME Supplier - Medical Supply Company 5193844439 Practice locations: Ormond Beach, FL

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Home Delivery Incontinent Supplies115 E Granada Blvd, Ormond Beach, FL 32176-6634(800) 367-8360 Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Neuromuscular Elect Stimulators (NMES)/Supplies|Support Surfaces: Pressure Reducing Beds/Mats/Pads|(TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies|Canes and/or Crutches|Seat Lift Mechanisms|Walkers|Wheelchairs … Does not accept assignmentParticipating since Dec 3, 2010

National Provider Directory

National Provider Directory
Tax ID family
Home Delivery Incontinent Supplies Co Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

1310 S Ridgewood Ave
Daytona Beach, FL 32114

115 E Granada Blvd
Ste 6
Ormond Beach, FL 32176
Phone (800) 367-8360

NPI Registry JSON

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

{
    "created_epoch": "1282435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1174839617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9385 DIELMAN INDUSTRIAL DR",
            "city": "OLIVETTE",
            "state": "MO",
            "postal_code": "631322214",
            "telephone_number": "314-997-8771",
            "fax_number": "314-997-0997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 E GRANADA BLVD STE 6",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321766634",
            "telephone_number": "800-367-8360",
            "fax_number": "888-874-4347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME DELIVERY INCONTINENT SUPPLIES CO INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JOURNEY DPC CORP",
        "enumeration_date": "2010-08-22",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "GOODWIN",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-997-8771"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002960300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HDIS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HDIS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ormond Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; 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.