NPIMap

Organization Active NPI

Martin Memorial Physician Corporation, Inc

Doing business as MHPG Tradition Pharmacy at Martin Health

  • Community/Retail Pharmacy
  • Port St Lucie, FL
National Provider Identifier
1407365513
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PH30943 Issued in FL
Legal business name
MARTIN MEMORIAL PHYSICIAN CORPORATION, INC
Doing business as
MHPG Tradition Pharmacy at Martin Health
Practice address
10080 SW Innovation Way Ste 102
Port St Lucie, FL 34987-2129
Phone
(772) 345-8166
Fax
(772) 345-8167
NPI assigned
Sep 21, 2017
Last updated
Dec 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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

Authorized official

Name
Timothy L. Longville
Title
Chief Accounting Officer/Controller
Phone
(216) 636-7416

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PH30943 FL Primary

Addresses

Primary practice location

10080 SW Innovation Way Ste 102
Port St Lucie, FL 34987-2129

Mailing address

10080 SW Innovation Way Ste 102
Port St Lucie, FL 34987-2129
Phone (772) 345-8166

Other names 1

  • MHPG Tradition Pharmacy at Martin Health Doing business as

National Provider Directory

National Provider Directory

Locations

10080 SW Innovation Way
Ste 102
Port St Lucie, FL 34987
Phone (772) 344-3811

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Practitioners & affiliated clinicians

Practitioners 7

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": "1505952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1407365513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10080 SW INNOVATION WAY STE 102",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872129",
            "telephone_number": "772-345-8166",
            "fax_number": "772-345-8167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10080 SW INNOVATION WAY STE 102",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872129",
            "telephone_number": "772-345-8166",
            "fax_number": "772-345-8167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN MEMORIAL PHYSICIAN CORPORATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-21",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "LONGVILLE",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER/CONTROLLER",
        "authorized_official_telephone_number": "216-636-7416"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH30943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MHPG Tradition Pharmacy at Martin Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.