NPIMap

Organization Active NPI

Florida Hospital Waterman Inc

Doing business as AdventHealth Waterman

  • General Acute Care Hospital
  • Tavares, FL
National Provider Identifier
1821019571
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
4409 Issued in FL
Legal business name
FLORIDA HOSPITAL WATERMAN INC
Doing business as
AdventHealth Waterman
Florida Hospital Waterman
Practice address
1000 Waterman Way
Tavares, FL 32778-5266
Phone
(352) 253-3333
Fax
(352) 253-3153
NPI assigned
Jul 21, 2006
Last updated
Jan 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Authorized official

Name
Mr. Andrii Korchuk
Title
Chief Financial Officer
Phone
(303) 524-5645

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 4409 FL Primary

Addresses

Primary practice location

1000 Waterman Way
Tavares, FL 32778-5266

Mailing address

770 W Granada Blvd Ste 203
Ormond Beach, FL 32174-5179
Phone (863) 231-4600

Other identifiers 4

IdentifierTypeStateIssuer
101904OtherFLAVMED
306OtherFLBLUE CROSS
010109500MedicaidFL
365068OtherFLBLACK LUNG

Other names 2

  • AdventHealth Waterman Doing business as
  • Florida Hospital Waterman Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler Other CMS HIH
CONNECT URL https://www.mettles.com/ Other

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050806000000 FL Part A Provider - Hospital 7416986864 Practice locations: Tavares, FL
O20220113000139 FL Part B Supplier - Intensive Cardiac Rehabilitation 7416986864 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tavares, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821019571. Details of each certification follow.

Hospital certification: CCN 100057

Legal name
FLORIDA HOSPITAL WATERMAN INC
Doing business as
ADVENTHEALTH WATERMAN
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 23, 2000
Beds
269
Ownership / control type
Church
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1992 in FL
Enrollment address
1000 Waterman Way
Tavares, FL 32778-5266
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Adventhealth WatermanCCN 100057 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Locations

770 W Granada Blvd
Ste 203
Ormond Beach, FL 32174
Phone (386) 231-4252

1922 Salk Ave
Tavares, FL 32778
Phone (352) 253-6365

3140 Waterman Way
Tavares, FL 32778
Phone (352) 253-3892

4000 Waterman Way
Tavares, FL 32778
Phone (352) 253-3600

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 30

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Michele Goeb-Burkett Individual Corporate DirectorDirector Dec 8, 2022
Christine Stewart Individual Corporate DirectorDirector Apr 4, 2024
Debora H Thomas Individual Corporate OfficerAssistant Secretary Aug 24, 2023
Douglas Hilliard Individual Corporate DirectorDirector Nov 21, 2025
Jeffrey Graff Individual Corporate OfficerAssistant Secretary Sep 11, 2014
Andrii Korchuk Individual Contracted Managing EmployeeCfo Dec 1, 2024
Corporate OfficerTreasurer Nov 21, 2025
Operational/Managerial ControlCfo Dec 1, 2024
Thomas L Werner Individual Corporate DirectorDirector Jun 7, 2007
Diane Godfrey Individual Corporate OfficerAssistant Secretary Jan 1, 2026
Robert Deininger Individual Corporate OfficerAssistant Secretary Nov 21, 2025
Patricia Elizabeth Smolter Individual Corporate DirectorDirector Apr 6, 2023
Michael Saunders Individual Corporate OfficerAssistant Secretary Feb 26, 2007
Pamela Simmons Individual Corporate DirectorDirector Apr 6, 2023
Marlyne Jean Pierre Individual Corporate DirectorDirector Apr 6, 2023
Brandon Nudd Individual Contracted Managing EmployeeCeo Oct 6, 2025
Corporate OfficerCeo/President/Secretary/Vice Chair Nov 21, 2025
Corporate DirectorDirector Nov 21, 2025
Operational/Managerial ControlCeo Oct 6, 2025
Barbara Howard Individual Corporate DirectorDirector Dec 17, 2009
Erika Skulla Individual Corporate OfficerBoard Chair Apr 9, 2026
Corporate DirectorDirector Apr 9, 2026
Susan Caddell Individual Corporate OfficerVice Chair Dec 12, 2024
Corporate DirectorDirector Jan 1, 2018
Adventist Health System Sunbelt Healthcare Corporation Organization, Altamonte Springs, FL Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Oct 1, 2000 100%
Amanda Brady Individual Corporate OfficerAssistant Secretary Feb 27, 2020
Toni Berrios Individual Corporate OfficerAssistant Secretary Dec 8, 2022
David Weiss Individual Corporate DirectorDirector Jun 9, 2011
Haney Vincent Individual Corporate OfficerAssistant Secretary Dec 9, 2021
Michael W Fountain Individual Corporate DirectorDirector Dec 8, 2022
Todd a Goodman Individual Corporate OfficerAssistant Secretary Sep 14, 2017
David L Huffman Individual Corporate OfficerAssistant Secretary Feb 27, 2020
Robert C Foltz Individual Corporate OfficerAssistant Secretary Sep 11, 2014
Lynn Addiscott Individual Corporate OfficerAssistant Secretary Jan 1, 2000
Sharlene Curet Individual Corporate DirectorDirector Apr 6, 2023
Gordon Noseworthy Individual Corporate DirectorDirector Apr 6, 2023
Beverly Morgan Individual Corporate OfficerAssistant Secretary Aug 21, 2025

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 85

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 85

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.

Affiliated clinicians 956

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 956

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737676800000",
    "number": "1821019571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 W GRANADA BLVD STE 203",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321745179",
            "telephone_number": "863-231-4600",
            "fax_number": "386-676-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 WATERMAN WAY",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327785266",
            "telephone_number": "352-253-3333",
            "fax_number": "352-253-3153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA HOSPITAL WATERMAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A",
        "authorized_official_last_name": "KORCHUK",
        "authorized_official_first_name": "ANDRII",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "303-524-5645",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "FL",
            "license": "4409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "101904",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "306",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010109500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "365068",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "CMS HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "AdventHealth Waterman",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AdventHealth Waterman",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Florida Hospital Waterman",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tavares, FL

Sources for this page

Verify at the official NPI Registry.