NPIMap

Organization Active NPI

Santrock Psychiatry, LLC

Doing business as Stillpoint Psychiatry

  • Psychiatry Physician
  • South Daytona, FL
National Provider Identifier
1811315104
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
ME101696 Issued in FL
Legal business name
SANTROCK PSYCHIATRY, LLC
Doing business as
Stillpoint Psychiatry
Practice address
2089 S Ridgewood Ave Ste B
South Daytona, FL 32119-2240
Phone
(386) 957-3905
Fax
(386) 492-1131
NPI assigned
Apr 3, 2014
Last updated
Nov 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

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

Authorized official

Name
Salvador Cevallos, MDNPI 1992926661
Title
Owner
Phone
(386) 957-3905

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
Psychiatry Physician 2084P0800X ME101696 FL Primary

Addresses

Primary practice location

2089 S Ridgewood Ave Ste B
South Daytona, FL 32119-2240

Mailing address

2089 S Ridgewood Ave Ste B
South Daytona, FL 32119-2240
Phone (386) 957-3905

Other names 1

  • Stillpoint Psychiatry Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150121001983 FL Part B Supplier - Clinic/Group Practice 3971827924 Receives reassigned benefits from 6 practitioners
Practice locations: Daytona Beach, FL

National Provider Directory

National Provider Directory

Locations

1913 N Clyde Morris Blvd
Ste 100
Daytona Beach, FL 32117

2089 S Ridgewood Ave
#2
South Daytona, FL 32119

2089 S Ridgewood Ave
Ste B
South Daytona, FL 32119
Phone (386) 322-2543

Practitioners & affiliated clinicians

Practitioners 6

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": "1396483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1811315104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2089 S RIDGEWOOD AVE STE B",
            "city": "SOUTH DAYTONA",
            "state": "FL",
            "postal_code": "321192240",
            "telephone_number": "386-957-3905",
            "fax_number": "386-492-1131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2089 S RIDGEWOOD AVE STE B",
            "city": "SOUTH DAYTONA",
            "state": "FL",
            "postal_code": "321192240",
            "telephone_number": "386-957-3905",
            "fax_number": "386-492-1131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTROCK PSYCHIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-03",
        "last_updated": "2023-11-07",
        "certification_date": "2023-10-27",
        "status": "A",
        "authorized_official_last_name": "CEVALLOS",
        "authorized_official_first_name": "SALVADOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-957-3905",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME101696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stillpoint Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Daytona, FL

Sources for this page

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