NPIMap

Organization Active NPI

Space Coast Prosthetics and Orthotics, Inc.

  • Prosthetist
  • Rockledge, FL
National Provider Identifier
1649664251
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthetistTaxonomy code 224P00000X
License
POR 134 Issued in FL
Legal business name
SPACE COAST PROSTHETICS AND ORTHOTICS, INC.
Practice address
590 Solutions Way Ste 100
Rockledge, FL 32955-3623
Phone
(321) 877-4732
Fax
(321) 877-4735
NPI assigned
Mar 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Authorized official

Name
Mr. Michael Pono McDowell, CPONPI 1598159329
Title
Vice President/Co-Owner
Phone
(321) 877-4732

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OrthotistGroup: 193200000X MULTI-SPECIALTY GROUP 222Z00000X POR 134 FL
ProsthetistGroup: 193200000X MULTI-SPECIALTY GROUP 224P00000X POR 134 FL Primary

Addresses

Primary practice location

590 Solutions Way Ste 100
Rockledge, FL 32955-3623

Mailing address

590 Solutions Way Ste 100
Rockledge, FL 32955-3623
Phone (321) 877-4732

Other identifiers 1

IdentifierTypeStateIssuer
15382200MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address office@spacecoastpo.com Direct Space Coast Prosthetics and Orthotics, Inc.

National Provider Directory

National Provider Directory

Locations

590 Solutions Way
Ste 100
Rockledge, FL 32955
Phone (321) 877-4732

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1426809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1649664251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 SOLUTIONS WAY STE 100",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329553623",
            "telephone_number": "321-877-4732",
            "fax_number": "321-877-4735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 SOLUTIONS WAY STE 100",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329553623",
            "telephone_number": "321-877-4732",
            "fax_number": "321-877-4735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST PROSTHETICS AND ORTHOTICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-20",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A",
        "authorized_official_last_name": "MCDOWELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "PONO",
        "authorized_official_title_or_position": "VICE PRESIDENT/CO-OWNER",
        "authorized_official_telephone_number": "321-877-4732",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthotist",
            "state": "FL",
            "license": "POR 134",
            "primary": false
        },
        {
            "code": "224P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Prosthetist",
            "state": "FL",
            "license": "POR 134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15382200",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "office@spacecoastpo.com",
            "affiliation": "Y",
            "endpointDescription": "office administrator email",
            "affiliationName": "Space Coast Prosthetics and Orthotics, Inc.",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "direct email to office",
            "address_1": "590 Solutions Way Ste 100",
            "city": "Rockledge",
            "state": "FL",
            "country_code": "US",
            "postal_code": "329553623",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rockledge, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.