Deland Family Medicine PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME912900 Issued in FL

Legal business name

DELAND FAMILY MEDICINE PA

Doing business as

DeLand Family Medicine

Practice address

1450 S Woodland Blvd
Suite 300C
Deland, FL 32720-7767

Phone

(386) 740-1701

Fax

(386) 740-1798

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Melanie R Vandemark, MD

Title

Owner

Phone

(386) 740-1701

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• DeLand Family Medicine Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melody Marie Johnson, PA-C

  • Physician Assistant
  • Longwood, FL
  • NPI 1427271907
  NPD (past)
• Judith Del Carmen Mathura, M.D.

  • Family Medicine Physician
  • Debary, FL
  • NPI 1609211069
  NPD (past)
• Heather Olson, ARNP

  • Family Nurse Practitioner
  • Greeneville, TN
  • NPI 1215233812
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1700997871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741240",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327741240",
            "telephone_number": "386-774-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 S WOODLAND BLVD",
            "address_2": "SUITE 300C",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327207767",
            "telephone_number": "386-740-1701",
            "fax_number": "386-740-1798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELAND FAMILY MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "VANDEMARK",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-740-1701",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME912900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PT AN",
            "identifier": "Q0182",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "52043",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DeLand Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deland Anesthesiology Group Inc
• Deland Athens Opco LLC (Deland Athens Post Acute)
• Deland Blue Lake Opco LLC (Deland Blue Lake Post Acute)
• Deland Central Physicians Assoc (Medical Treatment Center)
• Deland Dental
• Deland FL Alf Opco LLC (Blue Palms Senior Living of Deland)
• Deland FL Opco, LLC
• Deland Foot and Leg Center, LLC
• Deland Geriatric Care, Inc. (The Good Shepards-West of deLand)
• Deland Manor Assisted Living Corp

• Family Medicine Physician in Deland, FL
• Providers in Deland, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; 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.