Vitaliy Molchanov, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

157059 Issued in FL

Practice address

10000 SW Innovation Way
Port St Lucie, FL 34987-2111

Phone

(772) 345-8100

NPI assigned

Mar 22, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Martin Memorial Medical Center IncGroup PAC ID 2961300611, 514 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cleveland Clinic Martin North Hospital Hospital, Stuart, FL, CCN 100044

Merit-based Incentive Payment System (MIPS)

Final score

92.26 of 100Reported as apm

Quality

80.2

Promoting interoperability

99.24

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Martin Memorial Medical Center Inc

  • General Acute Care Hospital
  • Stuart, FL
  • NPI 1194790055
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Martin Memorial Medical Center Inc

  • General Acute Care Hospital
  • Stuart, FL
  • NPI 1194790055
  Care Compare affiliation

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

{
    "created_epoch": "1553212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1871053249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 HOSPITAL AVE",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068106099",
            "telephone_number": "203-739-8105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 SW INNOVATION WAY",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872111",
            "telephone_number": "772-345-8100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 Hospital Ave",
            "address_purpose": "LOCATION",
            "city": "Danbury",
            "state": "CT",
            "postal_code": "068106099",
            "country_code": "US",
            "telephone_number": "203-739-8105",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2401 W University Ave",
            "address_purpose": "LOCATION",
            "city": "Muncie",
            "state": "IN",
            "postal_code": "473033428",
            "country_code": "US",
            "telephone_number": "765-747-3111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOLCHANOV",
        "first_name": "VITALIY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-22",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "157059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael James Moffatt, DO
• Yahya Mohamad, DO
• Aaron Mohammed, MSW
• Moises Siperstein MD PA
• Raymond Molano, MD
• Carlos Molina
• Connor Molloy
• Monarch Behavior Analysis, LLC
• Monique Michelle Mondesir, M.D.
• Paul J Mondo, MD

• Internal Medicine Physician in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.