NPIMap

Individual provider Active NPI

Andre Stephen Prince, MD

  • Diagnostic Radiology Physician
  • Palm Coast, FL
National Provider Identifier
1548482151
Registry record updated May 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
ME99299 Issued in FL
Practice address
60 Memorial Medical Pkwy
Palm Coast, FL 32164-5980
Phone
(386) 586-2000
NPI assigned
May 3, 2007
Last updated
May 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X ME99299 FL
Diagnostic Radiology Physician 2085R0202X ME 99299 FL
Diagnostic Radiology Physician 2085R0202X 57561 KY
Diagnostic Radiology Physician 2085R0202X ME99299 FL Primary

Addresses

Primary practice location

60 Memorial Medical Pkwy
Palm Coast, FL 32164-5980

Mailing address

60 Memorial Medical Pkwy
Palm Coast, FL 32164-5980
Phone (386) 586-2000

Other identifiers 1

IdentifierTypeStateIssuer
'000709500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, KY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20081030000344 FL Practitioner - Diagnostic Radiology 5799844130 Reassigns benefits to 4 organizations
I20230927000303 KY Practitioner - Diagnostic Radiology 5799844130 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Drexel University College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mori Bean and Brooks IncGroup PAC ID 8820077878, 966 clinicians
Florida Hospital Medical Group IncGroup PAC ID 0042383200, 329 clinicians

Practice addresses (Care Compare)

2115 Little Rd
Trinity, FL 34655-4410
Phone (904) 399-5550

235 E Princeton St
Suite 100
Orlando, FL 32804-5554
Phone (407) 303-1414

4806 W Longfellow Ave
Tampa, FL 33629-7649
Phone (904) 399-5550

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 303-5600

661 E Altamonte Dr
Suite 130
Altamonte Springs, FL 32701-5102
Phone (407) 303-2155

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 99299FLMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mori Bean and Brooks Inc Neuroradiology CurrentSince Jun 9, 2024 Accepting new patients
Quality Medical Imaging of Arizona, Inc CurrentSince Jul 2, 2021 Accepting new patients
St Josephs Diagnostic Center LLC Diagnostic Radiology Current Accepting new patients
Sheridan Radiology Services of Pinellas, Inc. Diagnostic Radiology Current Accepting new patients
Florida Radiology Imaging at Lake Mary, LLC Neuroradiology CurrentSince Aug 3, 2020 Accepting new patients
St Joseph's Diagnostic Center LLC Diagnostic Radiology CurrentSince Feb 1, 2019 Accepting new patients
St Joseph's Diagnostic Center LLC Diagnostic Radiology CurrentSince Feb 1, 2019 Accepting new patients
Carrollwood Diagnostic Imaging Diagnostic Radiology Past Accepting new patients
Largo Radiology Consultants Past Accepting new patients
Tampa Bay Radiology Consultants Diagnostic Radiology Past Accepting new patients
South Bay Hospital Outpatient Diagnostic/Imaging Center Diagnostic Radiology Past Accepting new patients
Central Florida Imaging Associates Diagnostic Radiology Past Accepting new patients

Locations

119 Oakfield Dr
Brandon, FL 33511
Phone (813) 571-5150

17240 Cortez Blvd
Brooksville, FL 34601
Phone (352) 544-6060

900 Hope Way
Forest City, FL 32714
Phone (407) 357-1255

502 W Highland Blvd
Inverness, FL 34452
Phone (352) 344-6481

700 W Oak St
Kissimmee, FL 34741
Phone (407) 518-3553

201 14th St SW
Largo, FL 33770
Phone (727) 588-5222

2025 Indian Rocks Rd S
Largo, FL 33774
Phone (727) 581-9474

8300 Collier Blvd
Naples, FL 34114
Phone (239) 348-4000

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

235 E Princeton St
Ste 100
Orlando, FL 32804
Phone (407) 303-1414

14000 Fivay Rd
Port Richey, FL 34667
Phone (727) 819-2929

2500 Harbor Blvd
Pt Charlotte, FL 33952
Phone (941) 766-4122

13695 US Highway 1
Sebastian, FL 32958
Phone (772) 589-3185

4016 Sun City Center Blvd
Sun City Ctr, FL 33573
Phone (813) 634-0145

3003 W Mlk Blvd
Tampa, FL 33607
Phone (813) 357-0630

2115 Little Rd
Trinity, FL 34655
Phone 7278418225410

9330 State Road 54
Trinity, FL 34655
Phone (727) 834-4000

6001 Webb Rd
Twn North Cntry, FL 33615
Phone (813) 579-1402

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: aprince57535@adventhealth.direct-ci.com

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683849600000",
    "number": "1548482151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MEMORIAL MEDICAL PKWY",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321645980",
            "telephone_number": "386-586-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MEMORIAL MEDICAL PKWY",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321645980",
            "telephone_number": "386-586-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRINCE",
        "first_name": "ANDRE",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "FL",
            "license": "ME99299",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME 99299",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "KY",
            "license": "57561",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME99299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "'000709500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

Verify at the official NPI Registry.