John C. Devine

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

CGC Vigilant (Wmec-617)
9235 Grouper Road
Port Canaveral, FL 32920

Phone

(321) 853-7176

Fax

(321) 784-0382

NPI assigned

Apr 18, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659598274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CGC VIGILANT (WMEC-617)",
            "address_2": "9235 GROUPER ROAD",
            "city": "PORT CANAVERAL",
            "state": "FL",
            "postal_code": "32920",
            "telephone_number": "321-853-7176",
            "fax_number": "321-784-0382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CGC VIGILANT (WMEC-617)",
            "address_2": "9235 GROUPER ROAD",
            "city": "PORT CANAVERAL",
            "state": "FL",
            "postal_code": "32920",
            "telephone_number": "321-853-7176",
            "fax_number": "321-784-0382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVINE",
        "first_name": "JOHN",
        "middle_name": "C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deirdre Woolsey Ellis, PA

• Independent Duty Corpsman in Port Canaveral, FL
• Providers in Port Canaveral, FL by specialty
• Independent Duty Corpsman in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.