NPIMap

Organization Active NPI

Mobile Visiting Practitioners, LLC

  • Primary Care Nurse Practitioner
  • Daytona Beach, FL
National Provider Identifier
1265915359
Registry record updated Nov 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
MOBILE VISITING PRACTITIONERS, LLC
Practice address
140 S Beach St Ste 202
Daytona Beach, FL 32114-4409
Phone
(888) 506-8836
Fax
(888) 506-8837
NPI assigned
Sep 13, 2018
Last updated
Nov 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2020

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

Authorized official

Name
Edward R Kop
Title
Director of Operations
Phone
(352) 362-0627

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X NU Primary

Addresses

Primary practice location

140 S Beach St Ste 202
Daytona Beach, FL 32114-4409

Mailing address

140 S Beach St Ste 202
Daytona Beach, FL 32114-4409
Phone (888) 506-8836

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190507002879 FL Part B Supplier - Clinic/Group Practice 7810239100 Receives reassigned benefits from 38 practitioners
Practice locations: Daytona Beach, FL

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

140 S Beach St
Ste 202
Daytona Beach, FL 32114
Phone (888) 506-8836

Practitioners & affiliated clinicians

Practitioners 43

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.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604534400000",
    "number": "1265915359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 S BEACH ST STE 202",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321144409",
            "telephone_number": "888-506-8836",
            "fax_number": "888-506-8837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 S BEACH ST STE 202",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321144409",
            "telephone_number": "888-506-8836",
            "fax_number": "888-506-8837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE VISITING PRACTITIONERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-13",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A",
        "authorized_official_last_name": "KOP",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "352-362-0627"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; 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.