Individual provider Active NPI

Ted Robertson II, M.D.

  • Obstetrics & Gynecology Physician
  • Daytona Beach, FL
National Provider Identifier
1609849496
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
ME104386 Issued in FL
Practice address
500 Health Blvd
Daytona Beach, FL 32114-1492
Phone
(386) 252-5858
Fax
(386) 252-4477
NPI assigned
Feb 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X ME104386 FL Primary
Obstetrics & Gynecology Physician 207V00000X 35.071420 OH

Addresses

Primary practice location

500 Health Blvd
Daytona Beach, FL 32114-1492

Mailing address

500 Health Blvd
Daytona Beach, FL 32114-1492
Phone (386) 252-5858

Other identifiers 1

IdentifierTypeStateIssuer
002343800MedicaidFL

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110414000444 FL Practitioner - Obstetrics/Gynecology 7517141609 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Ohio State University College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vitalmd Group Holding LLCGroup PAC ID 8921091786, 535 clinicians

Practice addresses (Care Compare)

3225 Aviation Ave
Suite 700
Miami, FL 33133-4741
Phone (305) 273-4641

500 Health Blvd
Daytona Beach, FL 32114-1492
Phone (386) 252-5858

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME104386FLMDObstetrics & Gynecology Physician
35.071420OHMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Healthcare Partners, Inc CurrentSince Nov 4, 2024 Accepting new patients
Vitalmd Group Holding LLC Obstetrics & Gynecology CurrentSince Feb 6, 2011 Accepting new patients
Volusia OB GYN Obstetrics & Gynecology Current Accepting new patients

Locations

305 Memorial Medical Pkwy
Ste 401
Daytona Beach, FL 32117
Phone (386) 231-3540

500 Health Blvd
Daytona Beach, FL 32114
Phone (386) 252-5858

301 Memorial Medical Pkwy
Holly Hill, FL 32117
Phone (386) 231-3906

3225 Aviation Ave
Ste 700
Miami, FL 33133
Phone (305) 273-4641

1055 Saxon Blvd
Orange City, FL 32763
Phone (386) 917-5000

61 Memorial Medical Pkwy
Ste 1-800A
Palm Coast, FL 32164
Phone (386) 586-1810

60 Memorial Medical Pkwy
Palm Coast, FL 32164
Phone (385) 586-2000

3641 Clyde Morris Blvd
Ste 100
Port Orange, FL 32129
Phone (305) 500-2114

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BBHJCA

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1609849496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 HEALTH BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321141492",
            "telephone_number": "386-252-5858",
            "fax_number": "386-252-4477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 HEALTH BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321141492",
            "telephone_number": "386-252-5858",
            "fax_number": "386-252-4477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "TED",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME104386",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "35.071420",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002343800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.