Individual provider Active NPI

Kristy Chin, D.O.

  • Family Medicine Physician
  • Port Saint Lucie, FL
National Provider Identifier
1366184954
Registry record updated Aug 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS22423 Issued in FL
Practice address
10050 SW Innovation Way Ste 102
Port Saint Lucie, FL 34987-2117
Phone
(772) 344-3811
Fax
(772) 344-3890
NPI assigned
Apr 13, 2022
Last updated
Aug 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X OS22423 FL Primary

Addresses

Primary practice location

10050 SW Innovation Way Ste 102
Port Saint Lucie, FL 34987-2117

Mailing address

10050 SW Innovation Way Ste 102
Port Saint Lucie, FL 34987-2117
Phone (772) 344-3811

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20251014004295 FL Practitioner - Family Practice 8325428253 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

10050 SW Innovation Way
Suite 102
Port St Lucie, FL 34987-2117
Phone (772) 344-3811

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS22423FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Martin Memorial Medical Center Inc CurrentSince Oct 20, 2025 Accepting new patients
Martin Memorial Medical Center Inc Current Accepting new patients
Martin Memorial Physician Corporation Inc Past Accepting new patients

Locations

10050 SW Innovation Way
Ste 102
Port St Lucie, FL 34987
Phone (772) 288-5862

200 SE Hospital Ave
Stuart, FL 34994
Phone (772) 223-5618

Organizations & group practices 3

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

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755388800000",
    "number": "1366184954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10050 SW INNOVATION WAY STE 102",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349872117",
            "telephone_number": "772-344-3811",
            "fax_number": "772-344-3890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10050 SW INNOVATION WAY STE 102",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349872117",
            "telephone_number": "772-344-3811",
            "fax_number": "772-344-3890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHIN",
        "first_name": "KRISTY",
        "name_prefix": "Ms.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-13",
        "last_updated": "2025-08-17",
        "certification_date": "2025-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS22423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

Verify at the official NPI Registry.