NPIMap

Organization Active NPI

Space Coast Cardiology Consultants

  • Cardiovascular Disease Physician
  • Port St John, FL
National Provider Identifier
1225053176
Registry record updated Apr 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
SPACE COAST CARDIOLOGY CONSULTANTS
Practice address
7139 North Highway US # 1
Port St John, FL 32927-5094
Phone
(321) 635-8304
Fax
(321) 635-8252
NPI assigned
Jul 13, 2006
Last updated
Apr 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2025

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

Authorized official

Name
Laurie Holland
Title
Administrator
Phone
(352) 362-4223

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary

Addresses

Primary practice location

7139 North Highway US # 1
Port St John, FL 32927-5094

Mailing address

7139 North Highway US # 1
Port St John, FL 32927-5094
Phone (321) 635-8304

Other identifiers 1

IdentifierTypeStateIssuer
CL3045OtherFLRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050331000979 FL Part B Supplier - Clinic/Group Practice 9537116645 Receives reassigned benefits from 9 practitioners
Practice locations: Port St John, FL; Rockledge, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743984000000",
    "number": "1225053176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7139 NORTH HIGHWAY US # 1",
            "city": "PORT ST JOHN",
            "state": "FL",
            "postal_code": "329275094",
            "telephone_number": "321-635-8304",
            "fax_number": "321-635-8252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7139 NORTH HIGHWAY US # 1",
            "city": "PORT ST JOHN",
            "state": "FL",
            "postal_code": "329275094",
            "telephone_number": "321-635-8304",
            "fax_number": "321-635-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST CARDIOLOGY CONSULTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2025-04-07",
        "certification_date": "2025-03-25",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "352-362-4223"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CL3045",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St John, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; 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.