NPIMap

Organization Active NPI

Indian River Medical Office PA

  • Specialist
  • Titusville, FL
National Provider Identifier
1245220557
Registry record updated Mar 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
INDIAN RIVER MEDICAL OFFICE PA
Practice address
3300 Dairy Rd
Titusville, FL 32796-1512
Phone
(321) 269-6530
Fax
(321) 269-2334
NPI assigned
Oct 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2011

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

Authorized official

Name
Jill D Whittamore, CMM CPC
Title
Administrator
Phone
(321) 267-6687

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

3300 Dairy Rd
Titusville, FL 32796-1512

Mailing address

3300 Dairy Rd
Titusville, FL 32796-1512
Phone (321) 269-6530

Other identifiers 2

IdentifierTypeStateIssuer
250742100MedicaidFL
40745OtherFLBCBS FL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090902000508 FL Part B Supplier - Clinic/Group Practice 2668527201 Receives reassigned benefits from 4 practitioners
Practice locations: Titusville, FL

National Provider Directory

National Provider Directory

Locations

3300 Dairy Rd
Titusville, FL 32796
Phone (321) 267-6687

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BFFICA

Practitioners & affiliated clinicians

Practitioners 8

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": "1130371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299110400000",
    "number": "1245220557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 DAIRY RD",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327961512",
            "telephone_number": "321-269-6530",
            "fax_number": "321-269-2334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 DAIRY RD",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327961512",
            "telephone_number": "321-269-6530",
            "fax_number": "321-269-2334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN RIVER MEDICAL OFFICE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-27",
        "last_updated": "2011-03-03",
        "status": "A",
        "authorized_official_last_name": "WHITTAMORE",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "321-267-6687",
        "authorized_official_credential": "CMM CPC"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250742100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL",
            "identifier": "40745",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Titusville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2011; 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.