Intercoastal Medical Group Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

INTERCOASTAL MEDICAL GROUP INC

Practice address

11715 Rangeland Pkwy
Bradenton, FL 34211-9529

Phone

(941) 538-0001

NPI assigned

Sep 14, 2021

Last updated

Apr 8, 2026By 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

Mark J Ramos

Title

President

Phone

(941) 955-1108

Specialties & licenses 1

Addresses

Electronic endpoints 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://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.70573
• Direct secure messaging: rppcpdsm@img.directbygreenway.com

Practitioners 33

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.

• Michael James Bentze, DO

  • Family Medicine Physician
  • Bradenton, FL
  • NPI 1407840622
  NPD
• Allison Blair Blunden, PA-C

  • Physician Assistant
  • Bradenton, FL
  • NPI 1104149327
  NPD
• Renee Lynn Collins, AU.D.

  • Audiologist
  • Bradenton, FL
  • NPI 1972794105
  NPD
• Taylor Lloyd Dodgen

  • Dermatology Physician
  • Bradenton, FL
  • NPI 1275952780
  NPD
• Morgan Fonville, APRN

  • Nurse Practitioner
  • Bradenton, FL
  • NPI 1497413421
  NPD
• Jeffrey Gretz, MD

  • Gastroenterology Physician
  • Bradenton, FL
  • NPI 1306931209
  NPD
• Stacey Gruber, MD

  • Neurology Physician
  • Bradenton, FL
  • NPI 1790948073
  NPD
• Megan Lee Guerrero, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Tampa, FL
  • NPI 1194067520
  NPD
• Michael Ernst Hudack, ARNP

  • Nurse Practitioner
  • Bradenton, FL
  • NPI 1174712145
  NPD
• Ashley Kathleen Jackson, DNP, APRN, FNP-BC

  • Nurse Practitioner
  • Bradenton, FL
  • NPI 1851021984
  NPD
• Daniel James Johnson, MD

  • Family Medicine Physician
  • Bradenton, FL
  • NPI 1740206549
  NPD
• Jessica Hendrick Kassover, DO

  • Internal Medicine Physician
  • Bradenton, FL
  • NPI 1891283628
  NPD

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

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775606400000",
    "number": "1306516208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "943 S BENEVA RD STE 306",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342322473",
            "telephone_number": "941-955-1108",
            "fax_number": "941-954-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11715 RANGELAND PKWY",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342119529",
            "telephone_number": "941-538-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCOASTAL MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-14",
        "last_updated": "2026-04-08",
        "certification_date": "2026-04-08",
        "status": "A",
        "authorized_official_last_name": "RAMOS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "941-955-1108"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rppcpdsm@img.directbygreenway.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11715 Rangeland Pkwy",
            "city": "Bradenton",
            "state": "FL",
            "country_code": "US",
            "postal_code": "342119529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Medicine Physician in Bradenton, FL
• Providers in Bradenton, 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 Apr 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.