NPIMap

Organization Active NPI

Santa Rosa HB Medical Services LLC

  • Diagnostic Radiology Physician
  • Crestview, FL
National Provider Identifier
1730969502
Registry record updated Jun 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SANTA ROSA HB MEDICAL SERVICES LLC
Practice address
151 E Redstone Ave
Crestview, FL 32539-5352
Phone
(877) 892-9815
NPI assigned
Sep 29, 2023
Last updated
Jun 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

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

Authorized official

Name
Paula Durham
Title
VP Physician Business Services
Phone
(877) 892-9815

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU
Specialist 174400000X NU
Neuroradiology Physician 2085N0700X NU
Diagnostic Radiology Physician 2085R0202X NU Primary
Vascular & Interventional Radiology Physician 2085R0204X NU

Addresses

Primary practice location

151 E Redstone Ave
Crestview, FL 32539-5352

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-7377

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, CO, HI, CA, TX, PA, VA, IL, MD, WI, AK11 enrollments

Enrollment records 11

Enrollment IDStateProvider typePAC IDDetails
O20231010004073 FL Part B Supplier - Clinic/Group Practice 4284089335 Receives reassigned benefits from 90 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Weston, FL; West Palm Beach, FL; St Petersburg, FL; Palm City, FL; Orlando, FL; Milton, FL; Melbourne, FL; Crestview, FL…
O20231121001352 CO Part B Supplier - Clinic/Group Practice 4284089335 Receives reassigned benefits from 1 practitioner
Practice locations: Broomfield, CO
O20231129003415 HI Part B Supplier - Clinic/Group Practice 4284089335 Receives reassigned benefits from 1 practitioner
Practice locations: Honolulu, HI
O20231204002349 CA Part B Supplier - Clinic/Group Practice 4284089335 Receives reassigned benefits from 5 practitioners
Practice locations: Ontario, CA; Valencia, CA; Santa Barbara, CA; Rancho Palos Verdes, CA; Newport Beach, CA; Irvine, CA; Gardena, CA
O20231228000672 TX Part B Supplier - Clinic/Group Practice 4284089335 Receives reassigned benefits from 1 practitioner
Practice locations: Boerne, TX
O20240220002742 PA Part B Supplier - Clinic/Group Practice 4284089335 Receives reassigned benefits from 1 practitioner
Practice locations: Bethel Park, PA; Presto, PA
O20240802000310 VA Part B Supplier - Clinic/Group Practice 4284089335 Receives reassigned benefits from 1 practitioner
Practice locations: Virginia Beach, VA
O20241202002184 IL Part B Supplier - Clinic/Group Practice 4284089335 Receives reassigned benefits from 2 practitioners
Practice locations: Modesto, IL; South Barrington, IL
O20260114003653 MD Part B Supplier - Clinic/Group Practice 4284089335 Receives reassigned benefits from 1 practitioner
Practice locations: Ellicott City, MD
O20260602000492 WI Part B Supplier - Clinic/Group Practice 4284089335 Receives reassigned benefits from 1 practitioner
Practice locations: Middleton, WI
O20260602001017 AK Part B Supplier - Clinic/Group Practice 4284089335 Receives reassigned benefits from 1 practitioner
Practice locations: Anchorage, AK

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Santa Rosa HB Medical SVCS3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 40

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.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1695945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1730969502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-7377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 E REDSTONE AVE",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325395352",
            "telephone_number": "877-892-9815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA HB MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-29",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "DURHAM",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "VP PHYSICIAN BUSINESS SERVICES",
        "authorized_official_telephone_number": "877-892-9815"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.