NPIMap

Organization Active NPI

D.H. Medical, LLC

  • Family Medicine Physician
  • Port Orange, FL
National Provider Identifier
1477855815
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME83299 Issued in FL
Legal business name
D.H. MEDICAL, LLC
Practice address
735 Dunlawton Ave
Port Orange, FL 32127-9226
Phone
(888) 808-0488
Fax
(386) 872-4232
NPI assigned
Nov 17, 2010
Last updated
Oct 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Authorized official

Name
David A Heise, M.D.NPI 1740353465
Title
Owner
Phone
(386) 235-1489

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X ME83299 FL Primary

Addresses

Primary practice location

735 Dunlawton Ave
Port Orange, FL 32127-9226

Mailing address

735 Dunlawton Ave
Port Orange, FL 32127-9226
Phone (888) 808-0488

Other identifiers 1

IdentifierTypeStateIssuer
262487700MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101228000869 FL Part B Supplier - Clinic/Group Practice 6103014618 Receives reassigned benefits from 29 practitioners
Practice locations: Ormond Beach, FL

National Provider Directory

National Provider Directory

Locations

430 Oakridge Blvd
Daytona Beach, FL 32118
Phone (386) 215-2337

430 Oakridge Blvd
Ste 1
Daytona Beach, FL 32118

735 Dunlawton Ave
Port Orange, FL 32127
Phone (386) 872-5190

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1289952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1477855815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 DUNLAWTON AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321279226",
            "telephone_number": "888-808-0488",
            "fax_number": "386-872-4232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 DUNLAWTON AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321279226",
            "telephone_number": "888-808-0488",
            "fax_number": "386-872-4232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D.H. MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-17",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A",
        "authorized_official_last_name": "HEISE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-235-1489",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME83299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "262487700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.