Organization Active NPI

DMSP LLC

  • Podiatric Clinic/Center
  • Indian Harbour Beach, FL
National Provider Identifier
1376101923
Registry record updated May 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Podiatric Clinic/CenterTaxonomy code 261QP1100X
Legal business name
DMSP LLC
Practice address
2020 Highway A1A Ste 101
Indian Harbour Beach, FL 32937-3581
Phone
(321) 777-4774
NPI assigned
May 30, 2019
Last updated
May 30, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2019

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

Authorized official

Name
Eugene Wiggins
Title
Credentialing Manager
Phone
(904) 955-0562

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatric Clinic/Center 261QP1100X NU Primary

Addresses

Primary practice location

2020 Highway A1A Ste 101
Indian Harbour Beach, FL 32937-3581

Mailing address

1678 Maeve Cir
Melbourne, FL 32904-7348

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190730000530 FL Part B Supplier - Clinic/Group Practice 5799011797 Receives reassigned benefits from 2 practitioners
Practice locations: Indian Harbour Beach, FL; Cocoa Beach, FL

National Provider Directory

National Provider Directory

Locations

3000 N Atlantic Ave
Ste 108
Cocoa Beach, FL 32931
Phone (321) 213-1455

2020 Highway A1A
Ste 101
Indian Harbour Beach, FL 32937
Phone (321) 777-4774

2251 Town Center Ave
Ste 101
Melbourne, FL 32940
Phone (772) 779-1137

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559174400000",
    "number": "1376101923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1678 MAEVE CIR",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329047348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 HIGHWAY A1A STE 101",
            "city": "INDIAN HARBOUR BEACH",
            "state": "FL",
            "postal_code": "329373581",
            "telephone_number": "321-777-4774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DMSP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-30",
        "last_updated": "2019-05-30",
        "status": "A",
        "authorized_official_last_name": "WIGGINS",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "904-955-0562"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indian Harbour Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2019; 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.