Emerald Waters Medical Clinic LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

EMERALD WATERS MEDICAL CLINIC LLC

Practice address

1005 College Blvd W
Suite B
Niceville, FL 32578-1060

Phone

(850) 279-6815

Fax

(850) 279-6817

NPI assigned

Jul 28, 2012

Last updated

Aug 3, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Mauricia Stanton, ARNPNPI 1114928157

Title

Owner/Provider

Phone

(850) 582-6059

Specialties & licenses 4

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://api.platform.athenahealth.com/10590/brand/1/csg/1/fhir/r4

Practitioners 2

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.

• Mauricia Dora Stanton, ARNP-BC

  • Nurse Practitioner
  • Niceville, FL
  • NPI 1114928157
  Medicare reassignment NPD Authorized official
• Kongsak Chantornsaeng, M.D.

  • Family Medicine Physician
  • Panama City, FL
  • NPI 1942250659
  Medicare reassignment NPD

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

{
    "created_epoch": "1343433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659484800000",
    "number": "1306192216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 COLLEGE BLVD W",
            "address_2": "SUITE B",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325781060",
            "telephone_number": "850-279-6815",
            "fax_number": "850-279-6817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 COLLEGE BLVD W",
            "address_2": "SUITE B",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325781060",
            "telephone_number": "850-279-6815",
            "fax_number": "850-279-6817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD WATERS MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-28",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A",
        "authorized_official_last_name": "STANTON",
        "authorized_official_first_name": "MAURICIA",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "850-582-6059",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "ARNP3114742",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "FL",
            "license": "ARNP3114742",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emerald Coast Periodontics
• Emerald Coast Periodontics, P.a.
• Emerald Coast Services (Comfort Keepers)
• Emerald Coast Speech Services LLC
• Emerald Coast Wellness Center, LLC
• Brittney Engelbrecht
• Stephen T Enguidanos, MD
• Christa Ernsberger, L.P.N.
• Patricia Lynn Etheridge, PT
• Ginny Rebecca Everton, PMHNP-BC

• Nurse Practitioner in Niceville, FL
• Providers in Niceville, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; 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.