NPIMap

Organization Active NPI

Suntree Endocrinology

  • Internal Medicine Physician
  • Melbourne, FL
National Provider Identifier
1679072375
Registry record updated Mar 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME53320 Issued in FL
Legal business name
SUNTREE ENDOCRINOLOGY
Practice address
6619 N Wickham Rd
Melbourne, FL 32940-2006
Phone
(321) 259-9500
Fax
(321) 253-1777
NPI assigned
Feb 8, 2018
Last updated
Mar 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2025

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

Authorized official

Name
Kelly Luby
Title
Billing Manager
Phone
(321) 259-9500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME53320 FL Primary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X ME81283 FL

Addresses

Primary practice location

6619 N Wickham Rd
Melbourne, FL 32940-2006

Mailing address

6619 N Wickham Rd
Melbourne, FL 32940-2006
Phone (321) 259-9500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180703000757 FL Part B Supplier - Clinic/Group Practice 7113273202 Receives reassigned benefits from 1 practitioner
Practice locations: Melbourne, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 74

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.

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741219200000",
    "number": "1679072375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6619 N WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402006",
            "telephone_number": "321-259-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6619 N WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402006",
            "telephone_number": "321-259-9500",
            "fax_number": "321-253-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNTREE ENDOCRINOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-08",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A",
        "authorized_official_last_name": "LUBY",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "321-259-9500"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME53320",
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "FL",
            "license": "ME81283",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.