Active NPI
Martin Antony Fidelia, PA
- Physician Assistant
- Palm Bay, FL
National Provider Identifier
1427370469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9105354
- Practice address
- 1421 Malabar Rd NE
Physicians Office BLDG #200
Palm Bay, FL 32907-2576 - Phone
- (321) 308-2660
- Fax
- (321) 984-9303
- NPI assigned
- Feb 18, 2010
- Last updated
- Jul 6, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9105354 | FL | Primary |
Addresses
Primary practice location
1421 Malabar Rd NE
Physicians Office BLDG #200
Palm Bay, FL 32907-2576
Mailing address
1421 Malabar Rd NE
Physicians Office BLDG #200
Palm Bay, FL 32907-2576
Phone (321) 308-2660
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA9105354 | Other | FL | MEDICAL LICENSE NUMBER |
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: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Orthopaedics & Sports Medicine Center | Current | Accepting new patients |
Locations
7710 S US Highway 1
Port St Lucie, FL 34952
Phone (772) 335-5300
Interoperability endpoints
- martinfidelia@cos.directglo.com
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.
-
dba Coastal Orthopaedic & Sports Medicine Center
- Specialist
- Port Saint Lucie, FL
- NPI 1245291988
-
- Emergency Medicine Physician
- Aventura, FL
- NPI 1043917180
-
- Specialist
- Stuart, FL
- NPI 1417271578
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341532800000",
"number": "1427370469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1421 MALABAR RD NE",
"address_2": "PHYSICIANS OFFICE BLDG #200",
"city": "PALM BAY",
"state": "FL",
"postal_code": "329072576",
"telephone_number": "321-308-2660",
"fax_number": "321-984-9303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1421 MALABAR RD NE",
"address_2": "PHYSICIANS OFFICE BLDG #200",
"city": "PALM BAY",
"state": "FL",
"postal_code": "329072576",
"telephone_number": "321-308-2660",
"fax_number": "321-984-9303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FIDELIA",
"first_name": "MARTIN",
"middle_name": "ANTONY",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-18",
"last_updated": "2012-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9105354",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE NUMBER",
"identifier": "PA9105354",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Palm Bay, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.