Space Coast Medical Consultants PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SPACE COAST MEDICAL CONSULTANTS PLLC

Practice address

502 Garden St
Titusville, FL 32796-3405

Phone

(321) 621-0478

NPI assigned

Apr 9, 2025

Organization subpart

No

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

Authorized official

Name

Gaurav Mathur, MDNPI 1588152367

Title

Ceo

Phone

(321) 621-0478

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

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

• Gaurav Narayan Mathur, MD

  • Addiction Medicine (Internal Medicine) Physician
  • Titusville, FL
  • NPI 1588152367

  Single Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1744156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744156800000",
    "number": "1285429571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 GARDEN ST",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327963405",
            "telephone_number": "321-621-0478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 GARDEN ST",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327963405",
            "telephone_number": "321-621-0478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST MEDICAL CONSULTANTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-09",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A",
        "authorized_official_last_name": "MATHUR",
        "authorized_official_first_name": "GAURAV",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "321-621-0478",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sovereign Healthcare of Titusville, LLC (Royal Oaks Nursing & Rehab Center)
• Space Coast Assisted Living LLC
• Space Coast Health Centers Inc
• Space Coast Medical Associates LLP
• Space Coast Medical Center
• Space Coast Ophthalmology LLC
• Space Coast Pain Relief Inc.
• Space Coast Radiology Associates
• Space Coast Urology, LLC (Justo Gonzalez, M.D.)
• Jan L. Spagnoli, DDS

• Internal Medicine Physician in Titusville, FL
• Providers in Titusville, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 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.