Florida Hospital Waterman Inc
Organization Active NPI Rehabilitation Hospital Unit · Ormond Beach, FL
NPI 1851940035 · NPPES record last updated Jan 24, 2025
Key facts
- NPI
- 1851940035
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Hospital Unit 273Y00000X
- Legal business name
- FLORIDA HOSPITAL WATERMAN INC
- Practice address
- 770 W Granada Blvd Ste 203
Ormond Beach, FL 32174-5179 - Phone
- (352) 253-3333
- NPI assigned
- Sep 10, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- FLORIDA HOSPITAL WATERMAN INC
Authorized official
- Name
- Andrii Korchuk
- Title
- Cfo
- Phone
- (303) 524-5645
Owners & managing parties with NPI records 2
-
Michael Warren Fountain, D.O.
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Member organizations 3
Related certifications (CCN) 1
Facilities with the same owner 85
Affiliated clinicians 9
-
Taranjeet Arora, DO, MS, RDN
-
Samir C Guru, D.O.
-
Suparna Manohar Rao, M.D.
-
Kami R Strong, MD
-
John Frederick, M.D.
Medicare Care Compare: Inpatient rehabilitation facility
- Listed as
- Adventhealth Waterman
- Ownership
- Non-profit
- Certified
- Jan 1, 2026
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Hospital certification: CCN 10T057
- Legal name
- FLORIDA HOSPITAL WATERMAN INC
- Doing business as
- ADVENTHEALTH WATERMAN
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 1, 1992 in FL
- Enrollment address
- 1000 Waterman Way
Tavares, FL 32778-5266 - Hospital subgroups
- Rehabilitation unit
All disclosed owners & managing parties 32
| Name | Role | Since | Share |
|---|---|---|---|
| Julian Coomes |
W-2 Managing Employee |
Sep 1, 2020 | |
| Operational/Managerial Control |
Sep 1, 2020 | ||
| Michele Goeb-Burkett |
Corporate Director |
Dec 8, 2022 | |
| Christine Stewart |
Corporate Director |
Apr 4, 2024 | |
| Debora H Thomas |
Corporate Officer |
Aug 24, 2023 | |
| Jeffrey Graff |
Corporate Officer |
Sep 11, 2014 | |
| Andrii Korchuk |
Contracted Managing Employee |
Dec 1, 2024 | |
| Corporate Officer |
Dec 12, 2024 | ||
| Operational/Managerial Control |
Dec 1, 2024 | ||
| Thomas L Werner |
Corporate Director |
Jun 7, 2007 | |
| Abel Biri |
Corporate Officer |
Jun 8, 2017 | |
| Corporate Director |
Jun 8, 2017 | ||
| Patricia Elizabeth Smolter |
Corporate Director |
Apr 6, 2023 | |
| Michael Saunders |
Corporate Officer |
Feb 26, 2007 | |
| Pamela Simmons |
Corporate Director |
Apr 6, 2023 | |
| Marlyne Jean Pierre |
Corporate Director |
Apr 6, 2023 | |
| Brandon Nudd |
Contracted Managing Employee |
Oct 6, 2025 | |
| Corporate Officer |
Oct 6, 2025 | ||
| Operational/Managerial Control |
Oct 6, 2025 | ||
| Barbara Howard |
Corporate Director |
Dec 17, 2009 | |
| Paul C Rathbun |
Corporate Officer |
Sep 11, 2014 | |
| Susan Caddell |
Corporate Officer |
Dec 12, 2024 | |
| Corporate Director |
Jan 1, 2018 | ||
| Adventist Health System Sunbelt Healthcare Corporation |
5% Or Greater Direct Ownership Interest | Oct 1, 2000 | 100% |
| Amanda Brady |
Corporate Officer |
Feb 27, 2020 | |
| Toni Berrios |
Corporate Officer |
Dec 8, 2022 | |
| David Weiss |
Corporate Director |
Jun 9, 2011 | |
| Haney Vincent |
Corporate Officer |
Dec 9, 2021 | |
| Michael W Fountain |
Corporate Director |
Dec 8, 2022 | |
| Todd Mazenko |
Corporate Director |
Jan 1, 2021 | |
| Todd a Goodman |
Corporate Officer |
Sep 14, 2017 | |
| Lorenzo Brown |
Corporate Officer |
Mar 28, 2025 | |
| Corporate Director |
Mar 27, 2025 | ||
| David L Huffman |
Corporate Officer |
Feb 27, 2020 | |
| Robert C Foltz |
Corporate Officer |
Sep 11, 2014 | |
| Lynn Addiscott |
Corporate Officer |
Jan 1, 2000 | |
| Fran Crunk |
Corporate Director |
Aug 21, 2025 | |
| Sharlene Curet |
Corporate Director |
Apr 6, 2023 | |
| Gordon Noseworthy |
Corporate Director |
Apr 6, 2023 | |
| Beverly Morgan |
Corporate Officer |
Aug 21, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191111001202 | FL | Part a Provider - Hospital | 7416986864 | Practice locations: Tavares, FL |
National Provider Directory
- Tax ID family
- Florida Hospital Waterman Inc
- Part of
- Florida Hospital Waterman Inc
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Hospital Unit | 273Y00000X | Yes |
Addresses
Primary practice location
770 W Granada Blvd Ste 203
Ormond Beach, FL 32174-5179
Mailing address
1000 Waterman Way
Tavares, FL 32778-5266
Other practice location 1
1000 Waterman Way
Tavares, FL 32778-5266
Phone (352) 253-3333
Other names
- AdventHealth Waterman
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://www.mettles.com/ | Other |
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- Florida Hospital Imaging LLC
- Florida Podiatry PA
- Florida Practice & Benefits Group Management LLC
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- Florida Spine and Wellness Institute Corporation
All providers in Ormond Beach, FL · Rehabilitation Hospital Unit in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.