Palm Coast Cardiovascular Institute PL

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME80454 Issued in FL

Legal business name

PALM COAST CARDIOVASCULAR INSTITUTE PL

Practice address

19 Old Kings Rd N Ste C101
Palm Coast, FL 32137-8261

Phone

(386) 446-6540

NPI assigned

Aug 25, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Domenic Marini, M.D.NPI 1184688251

Title

Owner/Medical Director

Phone

(386) 586-4404

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

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

Practitioners 2

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

• Domenic Marini, M.D.

  • Interventional Cardiology Physician
  • Palm Coast, FL
  • NPI 1184688251

  Specialist

  Medicare reassignment NPD Authorized official
• Kathleen M Brady, ARNP

  • Adult Health Nurse Practitioner
  • Palm Coast, FL
  • NPI 1568791630
  NPD (past)

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

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584662400000",
    "number": "1285881946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 OLD KINGS RD N STE C101",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378261",
            "telephone_number": "386-446-6540",
            "fax_number": "386-447-7148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 OLD KINGS RD N STE C101",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378261",
            "telephone_number": "386-446-6540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM COAST CARDIOVASCULAR INSTITUTE PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-25",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A",
        "authorized_official_last_name": "MARINI",
        "authorized_official_first_name": "DOMENIC",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "386-586-4404",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME80454",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosa Dilia Pacumio
• Ambria Jacquelyn Page, LCSW
• Brenda Sue Paine, RN
• Palm Coast Acupuncture LLC
• Palm Coast Alf Management LLC
• Palm Coast Counseling, LLC
• Palm Coast Dental, LLC
• Palm Coast Health Care Associates LLC
• Palm Coast Health Care Services, LLC
• Palm Coast Internal Medicine PA

• Specialist in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.