Emerald Medical, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EMERALD MEDICAL, LLC

Practice address

6200 20TH St Ste 378
Vero Beach, FL 32966-1014

Phone

(772) 307-9840

Fax

(786) 756-8419

NPI assigned

Mar 23, 2020

Organization subpart

No

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

Authorized official

Name

Ms. Amanda Lynn Espinal

Title

Coo

Phone

(772) 307-9840

Specialties & licenses 2

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 4

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

• Edil Josue Agosto Diaz

  • Emergency Medicine Physician
  • Carolina, PR
  • NPI 1609070978

  FL

  Medicare reassignment NPD
• Kristopher Hasenauer

  • Physician Assistant
  • Vero Beach, FL
  • NPI 1881098416
  Medicare reassignment
• Adrian M Marquez Ayala, L.M.H.C.

  • Mental Health Counselor
  • Melbourne, FL
  • NPI 1457869034
  NPD
• Brittney Olson, FNP-C

  • Family Nurse Practitioner
  • Vero Beach, FL
  • NPI 1982392536
  NPD

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

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711324800000",
    "number": "1720615693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 58TH AVE # 318",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329664647",
            "telephone_number": "772-307-9840",
            "fax_number": "786-756-8419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 20TH ST STE 378",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329661014",
            "telephone_number": "772-307-9840",
            "fax_number": "786-756-8419"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 NW University Blvd",
            "address_purpose": "LOCATION",
            "city": "Port Saint Lucie",
            "state": "FL",
            "postal_code": "349862209",
            "country_code": "US",
            "telephone_number": "772-307-9840",
            "fax_number": "786-756-8419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EMERALD MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-23",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A",
        "authorized_official_last_name": "ESPINAL",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "772-307-9840",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA",
            "identifier": "MH17648",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA",
            "identifier": "APRN11026541",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA LICENSE",
            "identifier": "ME102761",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA",
            "identifier": "HCC14445",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA",
            "identifier": "IMH23931",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA",
            "identifier": "MH22729",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA",
            "identifier": "SW15366",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA",
            "identifier": "PA9108369",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Kathryn Ellison
• Tiffany Jill Ellison
• Hazem Eluri, PHARMD
• Frank Elwin, M.D.
• Khaldoun Elzoobi, MD
• Emergency Medicine Associates Inc
• Emergency Physicians of Vero Beach LLC
• Ben D Emerson Jr., D.D.S., M.D.
• Emil Chiropractic LLC
• Kanessia Q Emory

• Family Medicine Physician in Vero Beach, FL
• Providers in Vero Beach, 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 Mar 25, 2024; 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.