NPIMap

Organization Active NPI

St Lucie Surgical Associates PA

  • Surgery Physician
  • Port St Lucie, FL
National Provider Identifier
1770730459
Registry record updated Sep 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
ST LUCIE SURGICAL ASSOCIATES PA
Practice address
8483 S US Highway 1
Suite 19
Port St Lucie, FL 34952-3360
Phone
(772) 873-8501
Fax
(772) 873-8516
NPI assigned
Aug 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2008

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

Authorized official

Name
Dr. Ian Anthony Concilio, M.D.
Title
Owner/Physician
Phone
(772) 873-8501

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X Primary
Trauma Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2086S0127X
Vascular Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2086S0129X
Surgical Oncology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2086X0206X

Addresses

Primary practice location

8483 S US Highway 1
Suite 19
Port St Lucie, FL 34952-3360

Mailing address

PO Box 7665
Port St Lucie, FL 34985-7665
Phone (772) 873-8501

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222732800000",
    "number": "1770730459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7665",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349857665",
            "telephone_number": "772-873-8501",
            "fax_number": "772-873-8516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8483 S US HIGHWAY 1",
            "address_2": "SUITE 19",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349523360",
            "telephone_number": "772-873-8501",
            "fax_number": "772-873-8516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUCIE SURGICAL ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-25",
        "last_updated": "2008-09-30",
        "status": "A",
        "authorized_official_last_name": "CONCILIO",
        "authorized_official_first_name": "IAN",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "772-873-8501",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Trauma Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Surgical Oncology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.