NPIMap

Organization Active NPI

Complete Cardiology Care, P.a.

  • Internal Medicine Physician
  • Ormond Beach, FL
National Provider Identifier
1851552665
Registry record updated Jun 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME72993 Issued in FL
Legal business name
COMPLETE CARDIOLOGY CARE, P.A.
Practice address
1240 W Granada Blvd FL 2
Ormond Beach, FL 32174-5915
Phone
(386) 672-1023
Fax
(386) 263-2996
NPI assigned
Jun 24, 2008
Last updated
Jun 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2022

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

Authorized official

Name
Huijian James Wang, MDNPI 1043488661
Title
Owner
Phone
(386) 672-1023

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X ME72993 FL Primary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X ME112914 FL
Clinical Cardiac Electrophysiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0001X ME101341 FL
Point of Service 305S00000X ME72993 FL

Addresses

Primary practice location

1240 W Granada Blvd FL 2
Ormond Beach, FL 32174-5915

Mailing address

PO Box 291427
Port Orange, FL 32129-1427
Phone (386) 672-1023

Other practice location 1

926 Saxon Blvd
Orange City, FL 32763-8313
Phone (386) 672-1023

Other names 1

  • Eric L.S. Lo, MD., PA Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080826000157 FL Part B Supplier - Clinic/Group Practice 9638244635 Receives reassigned benefits from 9 practitioners
Practice locations: Ormond Beach, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2186334Complete Cardiology Care LLC1240 W Granada Blvd - 2ND Floor, Ormond Beach, FL 32174Certificate of waiverJun 15, 2028

National Provider Directory

National Provider Directory

Locations

1240 W Granada Blvd
#22
Ormond Beach, FL 32174

Practitioners & affiliated clinicians

Practitioners 10

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": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654128000000",
    "number": "1851552665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 291427",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321291427",
            "telephone_number": "386-672-1023",
            "fax_number": "386-263-2996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 W GRANADA BLVD FL 2",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321745915",
            "telephone_number": "386-672-1023",
            "fax_number": "386-263-2996"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "926 Saxon Blvd",
            "address_purpose": "LOCATION",
            "city": "Orange City",
            "state": "FL",
            "postal_code": "327638313",
            "country_code": "US",
            "telephone_number": "386-672-1023",
            "fax_number": "386-263-2996",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COMPLETE CARDIOLOGY CARE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-24",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "HUIJIAN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-672-1023",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME72993",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME112914",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "FL",
            "license": "ME101341",
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "FL",
            "license": "ME72993",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eric L.S. Lo, MD., PA",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Eric L.S. Lo, MD., PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Ormond Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.