Individual provider Active NPI

Frank Joseph Listello Jr., M.D.

  • Internal Medicine Physician
  • Melbourne, FL
National Provider Identifier
1417950429
Registry record updated Jan 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME81115 Issued in FL
Practice address
6300 N Wickham Rd
Ste 101
Melbourne, FL 32940-2023
Phone
(321) 253-2169
Fax
(321) 253-1720
NPI assigned
May 23, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME81115 FL Primary

Addresses

Primary practice location

6300 N Wickham Rd
Ste 101
Melbourne, FL 32940-2023

Mailing address

1930 Admiralty Blvd
Rockledge, FL 32955-5213
Phone (321) 632-4407

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
I20041002000089 FL Practitioner - Emergency Medicine 4880663145

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
27330MDMDClinical Social Worker
ME81115FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wuesthoff Emergency Physicians-Melbourne PA Past Accepting new patients
Eastern Shore Emergency Medicine Physicians, LLC Past Accepting new patients
Wuesthoff Emergency Physicians PA Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294358400000",
    "number": "1417950429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 ADMIRALTY BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329555213",
            "telephone_number": "321-632-4407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 N WICKHAM RD",
            "address_2": "STE 101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402023",
            "telephone_number": "321-253-2169",
            "fax_number": "321-253-1720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISTELLO",
        "first_name": "FRANK",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2011-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME81115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.