Organization Active NPI

New Smyrna Orthopedics PA

  • Orthopaedic Surgery Physician
  • Edgewater, FL
National Provider Identifier
1760596902
Registry record updated May 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
NEW SMYRNA ORTHOPEDICS PA
Practice address
812 W Indian River Blvd
Edgewater, FL 32132-3429
Phone
(386) 426-1411
Fax
(386) 426-0457
NPI assigned
Aug 17, 2006
Last updated
May 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2023

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

Authorized official

Name
Charles Edward Kollmer, MDNPI 1821102047
Title
President
Phone
(386) 426-1411

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

812 W Indian River Blvd
Edgewater, FL 32132-3429

Mailing address

812 W Indian River Blvd
Edgewater, FL 32132-3429
Phone (386) 426-1411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040901000622 FL Part B Supplier - Clinic/Group Practice 2365417391 Receives reassigned benefits from 3 practitioners
Practice locations: Edgewater, FL
O20100930087138 FL DME Supplier - Physician - Orthopedic/Orthopedic Surgery 2365417391 Practice locations: Edgewater, FL

National Provider Directory

National Provider Directory

Locations

812 W Indian River Blvd
Edgewater, FL 32132
Phone (386) 426-1411

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683417600000",
    "number": "1760596902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 W INDIAN RIVER BLVD",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "321323429",
            "telephone_number": "386-426-1411",
            "fax_number": "386-426-0457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 W INDIAN RIVER BLVD",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "321323429",
            "telephone_number": "386-426-1411",
            "fax_number": "386-426-0457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW SMYRNA ORTHOPEDICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2023-05-07",
        "certification_date": "2023-05-07",
        "status": "A",
        "authorized_official_last_name": "KOLLMER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-426-1411",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2023; 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.