Jake Tenewitz, MD
Individual provider Active NPI Family Medicine Physician · Malabar, FL
NPI 1891436010 · NPPES record last updated Sep 21, 2023
Key facts
- NPI
- 1891436010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- ME164364 (FL)
- Practice address
- 775 Malabar Rd
Malabar, FL 32950-3112 - Phone
- (321) 241-6800
- Fax
- (321) 241-6890
- NPI assigned
- Apr 3, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241026000076 | SC | Order and Referring Only - Radiation Oncology |
1759763493 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | ME164364 | FL | Yes |
Addresses
Primary practice location
775 Malabar Rd
Malabar, FL 32950-3112
Mailing address
PO Box 1137
Melbourne, FL 32902-1137
Phone (321) 952-9696
Other providers in Malabar, FL
- Beth Ann Ruede
- Joanne Schneider
- Stephanie Sciortino
- Amanda Rose Sledz
- Meagan Sumner
- David H Todd
- Ana Elsa Trofibio
- Urgent Care Centers of Brevard County LLC
- David Joseph Weldon Jr.
- Sarah Elizabeth White
All providers in Malabar, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2023. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.