Organization Active NPI

Emerald Waters Primary Care P.L.L.C.

  • Internal Medicine Physician
  • Navarre, FL
National Provider Identifier
1548924350
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
EMERALD WATERS PRIMARY CARE P.L.L.C.
Practice address
7295 Navarre Pkwy
Navarre, FL 32566-7307
Phone
(850) 898-0149
NPI assigned
Oct 27, 2021
Last updated
Sep 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Authorized official

Name
Wendy Mulky
Title
Manager
Phone
(850) 341-0648

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary
Pediatrics Physician 208000000X

Addresses

Primary practice location

7295 Navarre Pkwy
Navarre, FL 32566-7307

Mailing address

7295 Navarre Pkwy
Navarre, FL 32566-7307
Phone (850) 898-0149

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220510000037 FL Part B Supplier - Clinic/Group Practice 0547653065 Receives reassigned benefits from 1 practitioner
Practice locations: Navarre, FL

National Provider Directory

National Provider Directory

Locations

7295 Navarre Pkwy
Navarre, FL 32566
Phone (850) 686-6163

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24579/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1548924350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7295 NAVARRE PKWY",
            "city": "NAVARRE",
            "state": "FL",
            "postal_code": "325667307",
            "telephone_number": "850-898-0149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7295 NAVARRE PKWY",
            "city": "NAVARRE",
            "state": "FL",
            "postal_code": "325667307",
            "telephone_number": "850-898-0149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD WATERS PRIMARY CARE P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-27",
        "last_updated": "2023-09-07",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "MULKY",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "850-341-0648"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Navarre, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; 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.