NPIMap

Organization Active NPI

Lewis & Klancke Cardiology PA

Doing business as Daytona Heart Group

  • Cardiovascular Disease Physician
  • Daytona Beach, FL
National Provider Identifier
1689395675
Registry record updated Sep 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
LEWIS & KLANCKE CARDIOLOGY PA
Doing business as
Daytona Heart Group
Practice address
655 N Clyde Morris Blvd
Daytona Beach, FL 32114-2324
Phone
(386) 258-8722
Fax
(386) 258-8659
NPI assigned
Sep 7, 2022
Last updated
Sep 16, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
LEWIS & KLANCKE CARDIOLOGY, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 16, 2022

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

Authorized official

Name
Kathleen T Phillips
Title
Credentialing Coordinator
Phone
(386) 258-8722

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary
Clinical Cardiac Electrophysiology Physician 207RC0001X NU
Interventional Cardiology Physician 207RI0011X NU
Nuclear Cardiology Physician 207UN0901X NU

Addresses

Primary practice location

655 N Clyde Morris Blvd
Daytona Beach, FL 32114-2324

Mailing address

695 N Clyde Morris Blvd
Daytona Beach, FL 32114-2321
Phone (386) 258-8722

Other identifiers 2

IdentifierTypeStateIssuer
378998500MedicaidFL
99279OtherFLMEDICARE

Other names 1

  • Daytona Heart Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cardiology Consultants7 organizations share this tax ID, including this one
Part of
Cardiology Consultants

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

655 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 252-5578

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663286400000",
    "number": "1689395675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142321",
            "telephone_number": "386-258-8722",
            "fax_number": "386-258-9443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142324",
            "telephone_number": "386-258-8722",
            "fax_number": "386-258-8659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWIS & KLANCKE CARDIOLOGY PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEWIS & KLANCKE CARDIOLOGY, P.A.",
        "enumeration_date": "2022-09-07",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "386-258-8722"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "378998500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "99279",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Daytona Heart Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Daytona Heart Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 16, 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.