Port Orange Endoscopy & Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

1227 Issued in FL

Legal business name

PORT ORANGE ENDOSCOPY & SURGERY CENTER LLC

Doing business as

AdventHealth Surgery Center Port Orange

Practice address

1185 Dunlawton Ave Ste 100
Port Orange, FL 32127-2906

Phone

(386) 777-7151

Fax

(386) 231-6545

NPI assigned

Aug 11, 2005

Last updated

Jul 17, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mairilise Pothin Owen

Title

Cfo

Phone

(407) 357-2427

Specialties & licenses 1

Addresses

Other names 1

• AdventHealth Surgery Center Port Orange Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

Port Orange Endoscopy and Surgery CenterCCN 10C0001449

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Networks

• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Practitioners 2

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.

• John T Tolland, MD

  • Colon & Rectal Surgery Physician
  • Port Orange, FL
  • NPI 1750383733
  NPD
• Kathleen Williams, MD

  • Colon & Rectal Surgery Physician
  • Ormond Beach, FL
  • NPI 1083616965
  NPD (past)

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784246400000",
    "number": "1619979580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1185 DUNLAWTON AVE STE 100",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272906",
            "telephone_number": "386-777-7151",
            "fax_number": "386-231-6545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1185 DUNLAWTON AVE STE 100",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272906",
            "telephone_number": "386-777-7151",
            "fax_number": "386-231-6545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 Memorial Cir Ste G",
            "address_purpose": "LOCATION",
            "city": "Ormond Beach",
            "state": "FL",
            "postal_code": "321745055",
            "country_code": "US",
            "telephone_number": "386-271-7105 x3",
            "fax_number": "386-231-6545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PORT ORANGE ENDOSCOPY & SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-11",
        "last_updated": "2026-07-17",
        "certification_date": "2026-07-17",
        "status": "A",
        "authorized_official_last_name": "POTHIN OWEN",
        "authorized_official_first_name": "MAIRILISE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "407-357-2427"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "1227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AdventHealth Surgery Center Port Orange",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Richard Polhill, BC-HIS
• Concetta Tina A Pomroy, M.A.
• Port Orange Acupuncture LLC
• Port Orange Adult Day Care, LLC
• Port Orange Chiropractic Inc
• Port Orange Gynecology LLC
• Port Orange Internists PA
• Port Orange Modern Dentistry, PA (Port Orange Modern Dentistry)
• Port Orange Pediatrics P a
• Port Orange Physical Therapy Limited Partnership

• Ambulatory Surgical Clinic/Center in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.