Individual provider Active NPI

Edward Supinski, MD

  • Internal Medicine Physician
  • Port Orange, FL
National Provider Identifier
1700854833
Registry record updated Feb 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME 80671 Issued in FL
Practice address
3691 Clyde Morris Blvd
Port Orange, FL 32129-2317
Phone
(386) 675-4411
Fax
(866) 542-5859
NPI assigned
Mar 14, 2006
Last updated
Feb 17, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME 80671 FL Primary

Addresses

Primary practice location

3691 Clyde Morris Blvd
Port Orange, FL 32129-2317

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168

Other identifiers 2

IdentifierTypeStateIssuer
259199500MedicaidFL
35630OtherFLBCBS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address edward.supinski.1@29601.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090811000371 FL Practitioner - Internal Medicine 0244384204 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Temple University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conviva Medical Center Management, LLCGroup PAC ID 4284717422, 507 clinicians

Practice addresses (Care Compare)

3691 S Clyde Morris Blvd
Port Orange, FL 32129-2317
Phone (386) 675-4411

5238 -16 Norwood Ave
Jacksonville, FL 32208-5005
Phone (904) 861-1222

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME 80671FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Inpatient Consultants of Florida, Inc Internal Medicine CurrentSince Sep 8, 2014 Accepting new patients
Inpatient Consultants of Florida Inc Internal Medicine CurrentSince Sep 8, 2014 Accepting new patients
Conviva Medical Center Management LLC Internal Medicine CurrentSince Jan 1, 2021 Accepting new patients
Img Medical Group de PA Internal Medicine PastSince Jan 19, 2025 Accepting new patients
Metcare of Florida, Inc Internal Medicine Past Accepting new patients

Locations

5238 Norwood Ave
#16
Jacksonville, FL 32208
Phone (904) 265-2050

6101 Blue Lagoon Dr
Ste 400
Miami, FL 33126
Phone (305) 500-2114

6101 Waterford District Dr
Ste 200
Miami, FL 33126
Phone (407) 533-6836

2001 W 68th St
Miami Lakes, FL 33016
Phone (305) 364-2151

350 7th St N
Naples, FL 34102
Phone (239) 436-5000

3641 Clyde Morris Blvd
Ste 100
Port Orange, FL 32129
Phone (305) 500-2114

3691 Clyde Morris Blvd
Port Orange, FL 32129
Phone (386) 675-4410

1430 SW Saint Lucie West Blvd
Ste 101
Port St Lucie, FL 34986
Phone (772) 877-3591

6000 49th St N
St Petersburg, FL 33709
Phone (727) 521-4411

3030 W Bearss Ave
Tampa, FL 33618
Phone (813) 932-2222

Interoperability endpoints

  • Direct secure messaging: edward.supinski.1@29601.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771286400000",
    "number": "1700854833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "fax_number": "386-676-7125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3691 CLYDE MORRIS BLVD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321292317",
            "telephone_number": "386-675-4411",
            "fax_number": "866-542-5859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPINSKI",
        "first_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME 80671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "259199500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "35630",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "edward.supinski.1@29601.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "3691 Clyde Morris Blvd",
            "city": "Port Orange",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321292317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

Verify at the official NPI Registry.