Community Medical Center of West Volusia PA

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

COMMUNITY MEDICAL CENTER OF WEST VOLUSIA PA

Practice address

1190 N Stone St
Deland, FL 32720-2511

Phone

(386) 738-1792

Fax

(386) 738-4865

NPI assigned

Nov 1, 2006

Last updated

Jul 2, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Marcelo R. Anayas, M.D.NPI 1114001559

Title

Medical Director

Phone

(386) 738-1792

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861579104. Details of each certification follow.

• CCN 103869 Rural health clinic · Active · Details

Rural health clinic certification: CCN 103869

Legal name

COMMUNITY MEDICAL CENTER OF WEST VOLUSIA PA

Doing business as

COMMUNITY MEDICAL CENTER

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Aug 4, 1994

Last certification

Sep 29, 2023

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Jul 24, 1994 in FL

Enrollment address

1190N Stone St
Deland, FL 32720-2511

Other NPIs with the same Medicare PAC ID 1

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

• Community Medical Center of West Volusia PA

  • Rural Health Clinic/Center
  • Orange City, FL
  • NPI 1992882245

  3870630676

  Same PAC ID

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 3

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

Owners & managing parties with NPI records 1

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

• Community Medical Center of West Volusia PA

  • Rural Health Clinic/Center
  • Orange City, FL
  • NPI 1992882245

  Operational/Managerial Control

  CMS ownership

Practitioners 5

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.

• Marcelo Ramos Anayas, M.D.

  • Internal Medicine Physician
  • Orange City, FL
  • NPI 1114001559
  Authorized official Same address or phone
• Concepcion Sorilla Anayas, M.D.

  • Pediatrics Physician
  • Deland, FL
  • NPI 1851475271
  NPD (past)
• Candice Watters Jones, M.D.

  • Pediatrics Physician
  • Orlando, FL
  • NPI 1417002809
  NPD (past)
• Bernavette Pamela Perry, A.R.N.P.

  • Pediatric Nurse Practitioner
  • Daytona Beach, FL
  • NPI 1376620534
  NPD (past)
• Sherene Andrea Roach, A.R.N.P.

  • Pediatric Nurse Practitioner
  • Orlando, FL
  • NPI 1750468922
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246492800000",
    "number": "1861579104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1190 N STONE ST",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327202511",
            "telephone_number": "386-738-1792",
            "fax_number": "386-738-4865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 N STONE ST",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327202511",
            "telephone_number": "386-738-1792",
            "fax_number": "386-738-4865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL CENTER OF WEST VOLUSIA PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2009-07-02",
        "status": "A",
        "authorized_official_last_name": "ANAYAS",
        "authorized_official_first_name": "MARCELO",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "386-738-1792",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660026300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Coleman, PT
• Sidney Graham Collins Sr., RPH
• Stephen Plunkett Coltharp IV, MD
• Comfortable Care Dental Health Professionals, P.a. (Woodland Dental Care)
• Community Medical Center of West Volusia
• Community Outreach Services
• Complete Wellness Chiropractic Center of Deland LLC (Complete Wellness Medical Center)
• Conficare Rehabilitation Solutions LLC
• Deborah L Conran, D.O.
• Dana Anthony Cooper Jr., D.C.

• Rural Health Clinic/Center in Deland, FL
• Providers in Deland, FL by specialty
• Rural Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.