NPIMap

Organization Active NPI

Metcare Daytona Beach

Doing business as Conviva Care Center

  • Family Medicine Physician
  • Daytona Beach, FL
National Provider Identifier
1427433135
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
METCARE DAYTONA BEACH
Doing business as
Conviva Care Center
Practice address
731 N Clyde Morris Blvd
Daytona Beach, FL 32114-1603
Phone
(386) 257-1626
NPI assigned
Jul 23, 2015
Organization subpart
Yes
Parent organization
METROPOLITAN HEALTH NETWORKS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Authorized official

Name
Jessica Marie Bonetti
Title
Associate Director
Phone
(305) 500-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

731 N Clyde Morris Blvd
Daytona Beach, FL 32114-1603

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2114

Other identifiers 1

IdentifierTypeStateIssuer
CX415BOtherFLMEDICARE PTAN

Other names 2

  • Conviva Care Center Doing business as
  • Humana Physician Group Other name

National Provider Directory

National Provider Directory
Tax ID family
Metcare of New Smyrna Beach29 organizations share this tax ID, including this one
Part of
Albert Zamek

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1437609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1427433135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2114",
            "fax_number": "305-370-6024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321141603",
            "telephone_number": "386-257-1626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METCARE DAYTONA BEACH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "METROPOLITAN HEALTH NETWORKS, INC",
        "enumeration_date": "2015-07-23",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "BONETTI",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "305-500-2000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CX415B",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conviva Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Humana Physician Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Humana Physician Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; 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.