NPIMap

Organization Active NPI

New Image Maxillofacial LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Melbourne, FL
National Provider Identifier
1194767707
Registry record updated May 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DN7413 Issued in FL
Legal business name
NEW IMAGE MAXILLOFACIAL LLC
Practice address
1325 S Pine St
Suite 102
Melbourne, FL 32901-3189
Phone
(321) 725-5377
Fax
(321) 951-3393
NPI assigned
Jun 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2014

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

Authorized official

Name
Dr. Richard W Schmid, DDSNPI 1740458934
Title
Manager
Phone
(321) 725-5377

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X DN7413 FL Primary

Addresses

Primary practice location

1325 S Pine St
Suite 102
Melbourne, FL 32901-3189

Mailing address

1325 S Pine St
Suite 102
Melbourne, FL 32901-3189
Phone (321) 725-5377

Other names 1

  • Richard W Schmid DDS PA Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140507000700 FL Part B Supplier - Clinic/Group Practice 6800029331 Receives reassigned benefits from 5 practitioners
Practice locations: Melbourne, FL; Rockledge, FL

National Provider Directory

National Provider Directory

Locations

1325 Pine St
Ste 102
Melbourne, FL 32901
Phone (321) 725-5377

7155 Turner Rd
Rockledge, FL 32955
Phone (321) 255-7724

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400457600000",
    "number": "1194767707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 S PINE ST",
            "address_2": "SUITE 102",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013189",
            "telephone_number": "321-725-5377",
            "fax_number": "321-951-3393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 S PINE ST",
            "address_2": "SUITE 102",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013189",
            "telephone_number": "321-725-5377",
            "fax_number": "321-951-3393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW IMAGE MAXILLOFACIAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2014-05-19",
        "status": "A",
        "authorized_official_last_name": "SCHMID",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "321-725-5377",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN7413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Richard W Schmid DDS PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.