NPIMap

Organization Active NPI

Cardiology Physicians Memorial, LLC

  • Cardiovascular Disease Physician
  • Daytona Beach, FL
National Provider Identifier
1740559855
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CARDIOLOGY PHYSICIANS MEMORIAL, LLC
Practice address
103 Memorial Medical Pkwy
Suite 200
Daytona Beach, FL 32117
Phone
(386) 615-1521
Fax
(386) 671-0694
NPI assigned
Dec 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2024

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

Authorized official

Name
Trenae Hoskin
Title
Administrator
Phone
(386) 615-1521

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

103 Memorial Medical Pkwy
Suite 200
Daytona Beach, FL 32117

Mailing address

103 Memorial Medical Pkwy
Suite 200
Daytona Beach, FL 32117-5121
Phone (386) 615-1521

Other practice location 1

600 Palmetto St
New Smyrna Beach, FL 32168-7327
Phone (386) 615-1521

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120321000853 FL Part B Supplier - Clinic/Group Practice 2567622954 Receives reassigned benefits from 14 practitioners
Practice locations: Daytona Beach, FL

National Provider Directory

National Provider Directory

Locations

103 Memorial Medical Pkwy
Ste 201
Daytona Beach, FL 32117

103 Memorial Medical Pkwy
Ste 300
Daytona Beach, FL 32117
Phone (386) 231-8800

305 Memorial Medical Pkwy
Ste 305
Daytona Beach, FL 32117
Phone (386) 673-0201

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1324252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1740559855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 MEMORIAL MEDICAL PKWY",
            "address_2": "SUITE 200",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175121",
            "telephone_number": "386-615-1521",
            "fax_number": "386-671-0694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 MEMORIAL MEDICAL PKWY",
            "address_2": "SUITE 200",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32117",
            "telephone_number": "386-615-1521",
            "fax_number": "386-671-0694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Palmetto St",
            "address_purpose": "LOCATION",
            "city": "New Smyrna Beach",
            "state": "FL",
            "postal_code": "321687327",
            "country_code": "US",
            "telephone_number": "386-615-1521",
            "fax_number": "386-671-0694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CARDIOLOGY PHYSICIANS MEMORIAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-19",
        "last_updated": "2024-05-02",
        "certification_date": "2024-04-23",
        "status": "A",
        "authorized_official_last_name": "HOSKIN",
        "authorized_official_first_name": "TRENAE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "386-615-1521"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 May 2, 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.