Anunporn Srisawat, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME 95967 Issued in FL

Practice address

4554 S Clyde Morris Blvd
Suite 2
Port Orange, FL 32129-5403

Phone

(386) 304-2990

NPI assigned

Jul 27, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Loma Linda University School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trilogy Home Healthcare Home health agency, Jacksonville, FL, CCN 107689
• Halifax Health Care at Home Home health agency, Port Orange, FL, CCN 108359
• Adventhealth Daytona Beach Hospital, Daytona Beach, FL, CCN 100068
• Halifax Health Medical Center Hospital, Daytona Beach, FL, CCN 100017
• Adventhealth New Smyrna Beach Hospital, New Smyrna Beach, FL, CCN 100014

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tui Family Medicine PL

  • Clinic/Center
  • Port Orange, FL
  • NPI 1386940013
  Medicare reassignment NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Altercare LLC

  • Home Health Agency
  • Jacksonville, FL
  • NPI 1871529347
  Care Compare affiliation
• Daytona Area Senior Services

  • Home Health Agency
  • Daytona Beach, FL
  • NPI 1194775395
  Care Compare affiliation
• Halifax Hospital Medical Center

  • General Acute Care Hospital
  • Daytona Beach, FL
  • NPI 1811991227
  Care Compare affiliation
• Memorial Health Systems Inc

  • General Acute Care Hospital
  • Daytona Beach, FL
  • NPI 1063426823
  Care Compare affiliation
• Memorial Health Systems Inc

  • Clinical Medical Laboratory
  • Daytona Beach, FL
  • NPI 1104696178

  Hospital

  Care Compare affiliation
• Southeast Volusia Healthcare Corporation

  • General Acute Care Hospital
  • New Smyrna Beach, FL
  • NPI 1871977942
  Care Compare affiliation

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

{
    "created_epoch": "1185494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318377600000",
    "number": "1295925030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290035",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321290035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4554 S CLYDE MORRIS BLVD",
            "address_2": "SUITE 2",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321295403",
            "telephone_number": "386-304-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRISAWAT",
        "first_name": "ANUNPORN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-27",
        "last_updated": "2011-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME 95967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deanna Kingsley Springer, M.D.
• Spruce Creek Counseling, LLC
• Spruce Creek Family Care
• Spruce Creek Mental Health Services, LLC
• Spruce Dental, LLC
• Shannon St Amant, D.C.
• Lisa St. Louis, PHARMD
• Stacy O'Brien Audiology
• Donna Starcher
• Catherine Susan Stark, RDH, ORALFACIAL MYOL

• Family Medicine Physician in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.