Active NPI
Southwest Volusia Healthcare Corporation
Doing business as Adventhealth Medical Group
- Internal Medicine Physician
- Orange City, FL
National Provider Identifier
1902095078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- SOUTHWEST VOLUSIA HEALTHCARE CORPORATION
- Doing business as
- Adventhealth Medical Group
Southwest Volusia Medical Associates - Practice address
- 1055 Saxon Blvd
Orange City, FL 32763-8468 - Phone
- (386) 917-5000
- Fax
- (386) 917-5848
- NPI assigned
- Oct 15, 2007
- Last updated
- Feb 26, 2021
- Organization subpart
- Yes
- Parent organization
- SOUTHWEST VOLUSIA HEALTHCARE CORPORATION
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Kyle Glass
- Title
- Chief Financial Officer
- Phone
- (386) 917-5017
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | |||
| Internal Medicine Physician | 207R00000X | Primary | ||
| General Practice Physician | 208D00000X |
Addresses
Primary practice location
1055 Saxon Blvd
Orange City, FL 32763-8468
Mailing address
770 W Granada Blvd Ste 203
Ormond Beach, FL 32174-5179
Phone (386) 231-4252
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21677 | Other | FL | BCBS FL |
Other names 2
- ADVENTHEALTH MEDICAL GROUP
- Southwest Volusia Medical Associates
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081028000553 | FL | Part A Provider - Hospital | 0446153308 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Deltona, FL; Orange City, FL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1902095078. Details of each certification follow.
Hospital certification: CCN 100072
- Legal name
- SOUTHWEST VOLUSIA HEALTHCARE CORPORATION
- Doing business as
- ADVENTHEALTH FISH MEMORIAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Aug 29, 2008
- Beds
- 175
- Ownership / control type
- Church
- Organization structure
- Corporation
- Incorporated
- Oct 22, 1992 in FL
- Enrollment address
- 1055 Saxon Blvd
Orange City, FL 32763-8468 - Hospital subgroups
- General, Acute care
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba AdventHealth Fish Memorial
- General Acute Care Hospital
- Orange City, FL
- NPI 1700978558
O20081028000553
Care Compare: Hospital
Medicare Care Compare- Listed as
- Adventhealth Fish Memorial
- Overall star rating
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Church
- Medicare certification status
- Active
- Emergency services
- Yes
National Provider Directory
National Provider Directory- Part of
- Adventhealth Medical Group
Member organizations 1
Organizations listed as members of this organization in the National Provider Directory.
-
dba AdventHealth Surgery Center Blue Springs
- Ambulatory Surgical Clinic/Center
- Orange City, FL
- NPI 1558580910
Member Of
Locations
1061 Medical Center Dr
Ste 202
Orange City, FL 32763
Phone (386) 775-0333
Ownership & related parties
All disclosed owners & managing parties 34
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Ralph Patterson | Corporate Director | Sep 13, 2007 | |
| Kurt H Bowman | Corporate Director | Jan 1, 2021 | |
| Debora H Thomas | Corporate Officer | Aug 24, 2023 | |
| Douglas Hilliard | Corporate Director | Aug 21, 2025 | |
| Jeffrey Graff | Corporate Officer | Sep 11, 2014 | |
| Samuel M Edwards | Corporate Director | Dec 12, 2024 | |
| Maria Rodriguez | Corporate Director | Apr 4, 2024 | |
| Rajiv Bahl | Corporate Director | Mar 24, 2023 | |
| Diane Godfrey | Corporate Officer | Jan 1, 2026 | |
| Jennifer Ambs | Corporate Officer | Feb 20, 2025 | |
| Derek C Jackson | Corporate Director | Apr 3, 2025 | |
| Jeff L Ritchey | Corporate Director | Sep 17, 2015 | |
| Robert Deininger | Corporate Officer | Jun 13, 2025 | |
| Corporate Director | Jun 13, 2025 | ||
| Curtis Robinson | Corporate Director | Jul 2, 2026 | |
| Kenneth Zill | Contracted Managing Employee | Oct 21, 2025 | |
| Corporate Officer | Sep 20, 2025 | ||
| Operational/Managerial Control | Oct 21, 2025 | ||
| Marisa Farabaugh | Corporate Officer | Apr 9, 2026 | |
| Michael Saunders | Corporate Officer | Feb 22, 2007 | |
| John Wanamaker | Corporate Director | Sep 11, 2014 | |
| Craig Baker | Corporate Director | Nov 3, 2023 | |
| Francis Owens | Corporate Director | Feb 20, 2026 | |
| Adventist Health System Sunbelt Healthcare Corporation | 5% Or Greater Indirect Ownership Interest | Aug 21, 1998 | 100% |
| Amanda Brady | Corporate Officer | Feb 27, 2020 | |
| Shrish Calla | Corporate Director | Feb 22, 2018 | |
| Toni Berrios | Corporate Officer | Aug 25, 2022 | |
| Haney Vincent | Corporate Officer | Dec 9, 2021 | |
| Douglas Pytlinski | Corporate Officer | Apr 9, 2026 | |
| Lorenzo Brown | Corporate Officer | Apr 3, 2025 | |
| Corporate Director | Jun 9, 2016 | ||
| David L Huffman | Corporate Officer | Feb 27, 2020 | |
| Robert C Foltz | Corporate Officer | Sep 11, 2014 | |
| Patricia Northey | Corporate Director | Sep 13, 2007 | |
| Lynn Addiscott | Corporate Officer | Aug 18, 2005 | |
| Beverly Morgan | Corporate Officer | Aug 21, 2025 | |
| Adventist Health System Sunbelt Inc | 5% Or Greater Direct Ownership Interest | Aug 21, 1998 | 100% |
| Eric Lunde | Contracted Managing Employee | Feb 9, 2025 | |
| Corporate Officer | Sep 26, 2022 | ||
| Corporate Director | Sep 26, 2022 | ||
| Operational/Managerial Control | Feb 9, 2025 |
Owners & managing parties with NPI records 5
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
Practitioners & affiliated clinicians
Practitioners 36
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.
-
- Cardiovascular Disease Physician
- Orange City, FL
- NPI 1710945761
-
- Family Nurse Practitioner
- Orange City, FL
- NPI 1609327337
-
- Interventional Cardiology Physician
- Orange City, FL
- NPI 1013995406
-
- Cardiovascular Disease Physician
- Orange City, FL
- NPI 1669430732
-
- Cardiovascular Disease Physician
- Orange City, FL
- NPI 1164736211
-
- Gastroenterology Physician
- Deland, FL
- NPI 1376791798
Internal Medicine
-
- Cardiovascular Disease Physician
- Lake Mary, FL
- NPI 1851497242
-
- Nurse Practitioner
- Debary, FL
- NPI 1447710157
-
- Family Nurse Practitioner
- Daytona Beach, FL
- NPI 1073107587
-
- Specialist
- Deland, FL
- NPI 1386706000
-
- Interventional Cardiology Physician
- Lake Mary, FL
- NPI 1790827715
Internal Medicine
-
- Internal Medicine Physician
- Deltona, FL
- NPI 1467603183
Affiliated clinicians 669
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Hospitalist Physician
- Deland, FL
- NPI 1578862967
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192406400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1614297600000",
"number": "1902095078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "770 W GRANADA BLVD STE 203",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321745179",
"telephone_number": "386-231-4252",
"fax_number": "386-676-2560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 SAXON BLVD",
"city": "ORANGE CITY",
"state": "FL",
"postal_code": "327638468",
"telephone_number": "386-917-5000",
"fax_number": "386-917-5848"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHWEST VOLUSIA HEALTHCARE CORPORATION",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SOUTHWEST VOLUSIA HEALTHCARE CORPORATION",
"enumeration_date": "2007-10-15",
"last_updated": "2021-02-26",
"certification_date": "2021-02-26",
"status": "A",
"authorized_official_last_name": "GLASS",
"authorized_official_first_name": "KYLE",
"authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
"authorized_official_telephone_number": "386-917-5017",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS FL",
"identifier": "21677",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "ADVENTHEALTH MEDICAL GROUP",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Southwest Volusia Medical Associates",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Southwest Volusia Medical Associates",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Orange City, FL
- Elisabeth Sosa, ARNP
- Shaila Sosa
- Southwest Volusia Healthcare Corporation (AdventHealth Medical Group)
- Southwest Volusia Healthcare Corporation (AdventHealth Outpatient Pharmacy Fish Memorial)
- Southwest Volusia Healthcare Corporation (AdventHealth Fish Memorial)
- Specialty Furniture Products Inc.
- Richard Lloyd Speicher II, PA C
- David A Spellman, RMHCI, RMFTI, NCC
- Natalie Kelly Speranzo-Otero, APRN
- Eliana Jonay Spurlock
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; 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.