21St Century Oncology LLC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

21ST CENTURY ONCOLOGY LLC

Doing business as

Okaloosa-Walton Urology

Practice address

131 E Redstone Ave
Suite 102
Crestview, FL 32539-5326

Phone

(850) 682-6333

Fax

(850) 682-0865

NPI assigned

Jun 15, 2010

Last updated

Feb 3, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

RADIATION THERAPY SERVICES INCAs reported in NPPES

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

Authorized official

Name

Dianna Harrison

Title

Sr. Director of Provider Relations

Phone

(239) 931-7342

Specialties & licenses 2

Addresses

Other names 1

• Okaloosa-Walton Urology Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 5

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.

• Yan G Makeyev, MD

  • Hematology & Oncology Physician
  • Orange Park, FL
  • NPI 1386812253
  NPD
• Dwelvin L Simmons, MD

  • Radiation Oncology Physician
  • Orange Park, FL
  • NPI 1740247311
  NPD
• Ted Chung, M.D.

  • Urology Physician
  • Destin, FL
  • NPI 1639148166
  NPD (past)
• Kapil Puri, M.D.

  • Urology Physician
  • Niceville, FL
  • NPI 1962494211
  NPD (past)
• Thomas Zachos, M.D.

  • Urology Physician
  • Fort Walton Beach, FL
  • NPI 1457329591
  NPD (past)

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

{
    "created_epoch": "1276560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738540800000",
    "number": "1346561289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2234 COLONIAL BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071412",
            "telephone_number": "239-931-7342",
            "fax_number": "239-931-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 E REDSTONE AVE",
            "address_2": "SUITE 102",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325395326",
            "telephone_number": "850-682-6333",
            "fax_number": "850-682-0865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "21ST CENTURY ONCOLOGY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RADIATION THERAPY SERVICES INC",
        "enumeration_date": "2010-06-15",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "DIANNA",
        "authorized_official_title_or_position": "SR. DIRECTOR OF PROVIDER RELATIONS",
        "authorized_official_telephone_number": "239-931-7342"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Okaloosa-Walton Urology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Okaloosa-Walton Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Aaron B Stein MD PLLC (The Pain Management Group)

• Urology Physician in Crestview, FL
• Providers in Crestview, FL by specialty
• Urology Physician in Florida

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