NPIMap

Organization Active NPI

Embry-Riddle Aeronautical University, Inc.

  • General Practice Physician
  • Daytona Beach, FL
National Provider Identifier
1679097307
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
EMBRY-RIDDLE AERONAUTICAL UNIVERSITY, INC.
Practice address
600 S Clyde Morris Blvd
Daytona Beach, FL 32114-3966
Phone
(386) 226-7912
NPI assigned
Aug 3, 2017
Organization subpart
Yes
Parent organization
EMBRY-RIDDLE AERONAUTICAL UNIVERSITY, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Marianne Baskin
Title
Director
Phone
(386) 226-7912

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

600 S Clyde Morris Blvd
Daytona Beach, FL 32114-3966

Mailing address

600 S Clyde Morris Blvd
Daytona Beach, FL 32114-3966
Phone (386) 226-7912

National Provider Directory

National Provider Directory
Part of
Embry Riddle Wellness Center

Locations

3700 Willow Creek Rd
Prescott, AZ 86301
Phone (928) 777-6653

1 Aerospace Blvd
Daytona Beach, FL 32114
Phone (386) 226-7583

600 S Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 226-7785

Practitioners & affiliated clinicians

Practitioners 5

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": "1501718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1679097307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321143966",
            "telephone_number": "386-226-7912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321143966",
            "telephone_number": "386-226-7912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBRY-RIDDLE AERONAUTICAL UNIVERSITY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMBRY-RIDDLE AERONAUTICAL UNIVERSITY, INC.",
        "enumeration_date": "2017-08-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BASKIN",
        "authorized_official_first_name": "MARIANNE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "386-226-7912"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.