NPIMap

Organization Active NPI

Island Direct Primary Care LLC

  • Primary Care Clinic/Center
  • Merritt Island, FL
National Provider Identifier
1811463961
Registry record updated Mar 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ISLAND DIRECT PRIMARY CARE LLC
Practice address
390 N Courtenay Pkwy
Merritt Island, FL 32953-3456
Phone
(321) 506-2540
NPI assigned
Oct 16, 2018
Last updated
Mar 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2022

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

Authorized official

Name
Dr. John Wesley Rothwell III, DNPNPI 1679943740
Title
President
Phone
(321) 506-2540

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
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

390 N Courtenay Pkwy
Merritt Island, FL 32953-3456

Mailing address

210 Hickory Ave
Merritt Island, FL 32953-4368
Phone (321) 506-2540

Other identifiers 1

IdentifierTypeStateIssuer
1679943740MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address john@islanddirectprimarycare.com Direct

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: john@islanddirectprimarycare.com

Practitioners & affiliated clinicians

Practitioners 1

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": "1539648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648339200000",
    "number": "1811463961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 HICKORY AVE",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329534368",
            "telephone_number": "321-506-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 N COURTENAY PKWY",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329533456",
            "telephone_number": "321-506-2540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND DIRECT PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-16",
        "last_updated": "2022-03-27",
        "certification_date": "2022-03-27",
        "status": "A",
        "authorized_official_last_name": "ROTHWELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WESLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-506-2540",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679943740",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john@islanddirectprimarycare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "390 N Courtenay Pkwy",
            "city": "Merritt Island",
            "state": "FL",
            "country_code": "US",
            "postal_code": "329533456",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2022; 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.