Individual provider Active NPI

Kenneth J Urban, M.D.

  • Family Medicine Physician
  • Port St Lucie, FL
National Provider Identifier
1609884899
Registry record updated Jun 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME33161 Issued in FL
Practice address
1651 SE Tiffany Ave
Port St Lucie, FL 34952-7564
Phone
(772) 398-1800
Fax
(772) 398-1815
NPI assigned
Aug 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME33161 FL Primary

Addresses

Primary practice location

1651 SE Tiffany Ave
Port St Lucie, FL 34952-7564

Mailing address

PO Box 417
Stuart, FL 34995-0417
Phone (772) 223-5665

Other identifiers 1

IdentifierTypeStateIssuer
0372366600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, TX, HI3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20100713000687 FL Practitioner - Family Practice 3971635848 Reassigns benefits to 6 organizations
I20140403002182 TX Practitioner - Family Practice 3971635848 Reassigns benefits to 1 organization
I20230119002230 HI Practitioner - Family Practice 3971635848 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME33161FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Boynton Urgent Care, LLC Family Medicine CurrentSince Mar 27, 2021 Accepting new patients
MCR Health, Inc. CurrentSince Aug 1, 2018 Accepting new patients
Molokai General Hospital CurrentSince Feb 13, 2023 Accepting new patients
DHHS,PHS,Naihs, Gallup Indian Medical Center CurrentSince Feb 24, 2014 Accepting new patients
Carespot of Orlando Hsi Urgent Care LLC Family Medicine CurrentSince Oct 22, 2020 Accepting new patients
Solantic/South Florida, LLC CurrentSince Mar 27, 2021 Accepting new patients
Molokai General Hospital CurrentSince Feb 13, 2023 Accepting new patients
Shands/Solantic Joint Venture, LLC CurrentSince Nov 22, 2020 Accepting new patients
MCR Health, Inc. Family Medicine CurrentSince Aug 1, 2018 Accepting new patients
Hma/Solantic Joint Venture, LLC CurrentSince Mar 27, 2021 Accepting new patients
Martin Memorial Medical Center Inc Past Accepting new patients
Martin Memorial Physician Corporation Inc PastSince Apr 1, 2004 Accepting new patients

Locations

512 E Altamonte Dr
Ste 1000
Altamonte Springs, FL 32701
Phone (321) 319-0212

3840 State Road 436
Ste 1
Apopka, FL 32703
Phone (407) 478-3202

8756 Boynton Rd W
Ste 150
Boynton Beach, FL 33472
Phone (561) 740-2273

1615 E Highway 50
Ste 200
Clermont, FL 34711
Phone (352) 404-4463

720 SW 2nd Ave
Ste 160A
Gainesville, FL 32601
Phone (352) 240-8000

3925 NW 43rd St
Gainesville, FL 32606
Phone (352) 371-1777

18706 NW 67th Ave
Miami Gardens, FL 33015
Phone (786) 563-0280

12271 US Highway 301 N
Parrish, FL 34219
Phone (941) 713-2231

9035 Pines Blvd
Pembroke Pines, FL 33024
Phone (954) 340-5881

1205 N University Dr
Pompano Beach, FL 33071
Phone (954) 780-8134

784 E Prima Vista Blvd
Port St Lucie, FL 34952
Phone (772) 878-7311

129 S State Road 7
Ste 401
Royal Palm Beach, FL 33414
Phone (561) 425-7801

1820 58th Ave
Ste 110
Vero Beach, FL 32966
Phone (772) 257-3200

516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306972800000",
    "number": "1609884899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 417",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349950417",
            "telephone_number": "772-223-5665",
            "fax_number": "772-223-5646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 SE TIFFANY AVE",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527564",
            "telephone_number": "772-398-1800",
            "fax_number": "772-398-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "URBAN",
        "first_name": "KENNETH",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2011-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME33161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0372366600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

Verify at the official NPI Registry.