NPIMap

Organization Active NPI

Urgent Care Center of Port Orange, LLC

Doing business as Advanced Urgent Care

  • Urgent Care Clinic/Center
  • Port Orange, FL
National Provider Identifier
1891905378
Registry record updated Jun 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
ME73758 Issued in FL
Legal business name
URGENT CARE CENTER OF PORT ORANGE, LLC
Doing business as
Advanced Urgent Care
Practice address
1690 Dunlawton Ave
Suite 120
Port Orange, FL 32127-8980
Phone
(386) 271-2273
Fax
(386) 271-2274
NPI assigned
May 23, 2007
Last updated
Jun 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

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

Authorized official

Name
Dr. Ammar Hemaidan, M.D.NPI 1033149752
Title
Ceo/Medical Director
Phone
(386) 271-2273

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X ME73758 FL Primary

Addresses

Primary practice location

1690 Dunlawton Ave
Suite 120
Port Orange, FL 32127-8980

Mailing address

1690 Dunlawton Ave
Suite 120
Port Orange, FL 32127-8980
Phone (386) 271-2273

Other names 1

  • Advanced Urgent Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051028000823 FL Part B Supplier - Clinic/Group Practice 5890712806 Receives reassigned benefits from 14 practitioners
Practice locations: Port Orange, 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
10D1042134Urgent Care Center of Port Orange, LLC1690 Dunlawton Avenue Suite #120, Port Orange, FL 32127Certificate of waiverFeb 17, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1891905378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1690 DUNLAWTON AVE",
            "address_2": "SUITE 120",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321278980",
            "telephone_number": "386-271-2273",
            "fax_number": "386-271-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 DUNLAWTON AVE",
            "address_2": "SUITE 120",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321278980",
            "telephone_number": "386-271-2273",
            "fax_number": "386-271-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URGENT CARE CENTER OF PORT ORANGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "HEMAIDAN",
        "authorized_official_first_name": "AMMAR",
        "authorized_official_title_or_position": "CEO/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "386-271-2273",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "FL",
            "license": "ME73758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; 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.