NPIMap

Organization Active NPI

Vascular Center of Orlando, P.a.

Doing business as Vascular Centers of Orlando

  • Vascular Surgery Physician
  • Orlando, FL
National Provider Identifier
1255331666
Registry record updated Oct 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
ME31846 Issued in FL
Legal business name
VASCULAR CENTER OF ORLANDO, P.A.
Doing business as
Vascular Centers of Orlando
Practice address
1200 Edgewater Dr
Orlando, FL 32804-6314
Phone
(407) 244-8559
Fax
(407) 244-8560
NPI assigned
Jul 28, 2005
Last updated
Oct 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2012

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

Authorized official

Name
Samuel Preston Martin IV, M.D.NPI 1124028436
Title
Owner
Phone
(407) 244-8559

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
Vascular Surgery Physician 2086S0129X ME31846 FL Primary

Addresses

Primary practice location

1200 Edgewater Dr
Orlando, FL 32804-6314

Mailing address

1200 Edgewater Dr
Orlando, FL 32804-6314
Phone (407) 244-8559

Other identifiers 2

IdentifierTypeStateIssuer
037049500MedicaidFL
060065287OtherFLCHAMPUS

Other names 1

  • Vascular Centers of Orlando Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120201000878 FL Part B Supplier - Clinic/Group Practice 5294796132 Receives reassigned benefits from 11 practitioners
Practice locations: Davenport, FL; Kissimmee, FL; Lake Mary, FL; Orlando, FL; Rockledge, FL; The Villages, FL

National Provider Directory

National Provider Directory

Locations

1128 Cypress Glen Cir
Kissimmee, FL 34741
Phone (352) 432-3910

1210 E Osceola Pkwy
Ste 303
Kissimmee, FL 34744
Phone (407) 847-8404

920 Rolling Acres Rd
#3
Lady Lake, FL 32159
Phone (352) 750-5105

100 N Dean Rd
Ste 201
Orlando, FL 32825
Phone (407) 244-8559

1200 Edgewater Dr
Orlando, FL 32804
Phone (407) 244-8559

1315 S Orange Ave
#3B
Orlando, FL 32806
Phone (407) 244-8559

Practitioners & affiliated clinicians

Practitioners 11

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": "1122508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349827200000",
    "number": "1255331666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 EDGEWATER DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328046314",
            "telephone_number": "407-244-8559",
            "fax_number": "407-244-8560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 EDGEWATER DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328046314",
            "telephone_number": "407-244-8559",
            "fax_number": "407-244-8560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VASCULAR CENTER OF ORLANDO, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-28",
        "last_updated": "2012-10-10",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "PRESTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-244-8559",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "FL",
            "license": "ME31846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "037049500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "060065287",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vascular Centers of Orlando",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; 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.