NPIMap

Organization Active NPI

Independent Lung Associates, PA

  • Pulmonary Disease Physician
  • Melbourne, FL
National Provider Identifier
1912928045
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
INDEPENDENT LUNG ASSOCIATES, PA
Practice address
1314 Oak St
Melbourne, FL 32901-3111
Phone
(321) 727-7992
Fax
(321) 727-7664
NPI assigned
Jul 22, 2006
Last updated
Jan 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Authorized official

Name
Michele St Amand
Title
Office Manager
Phone
(321) 727-7992

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X Primary

Addresses

Primary practice location

1314 Oak St
Melbourne, FL 32901-3111

Mailing address

1314 Oak St
Melbourne, FL 32901-3111
Phone (321) 727-7992

Other practice location 1

32 Suntree Pl
Melbourne, FL 32940-7689
Phone (321) 727-7992

Other practice location 2

220 S Courtenay Pkwy Ste A
Merritt Island, FL 32952-4893
Phone (321) 727-7992

Other practice location 3

1326 Malabar Rd SE Ste 1
Palm Bay, FL 32907-2502
Phone (321) 727-7992

Other identifiers 2

IdentifierTypeStateIssuer
107102000MedicaidFL
269408501MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040526000918 FL Part B Supplier - Clinic/Group Practice 4789665738 Receives reassigned benefits from 24 practitioners
Practice locations: Melbourne, FL; Palm Bay, FL

National Provider Directory

National Provider Directory

Locations

1314 Oak St
Melbourne, FL 32901
Phone 3217277992114

930 S Harbor City Blvd
Ste 305
Melbourne, FL 32901

220 S Courtenay Pkwy
Ste A
Merritt Island, FL 32952
Phone (321) 868-7656

7955 Bay St
#5
Sebastian, FL 32958

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1912928045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1314 OAK ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013111",
            "telephone_number": "321-727-7992",
            "fax_number": "321-727-7664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 OAK ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013111",
            "telephone_number": "321-727-7992",
            "fax_number": "321-727-7664"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "32 Suntree Pl",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329407689",
            "country_code": "US",
            "telephone_number": "321-727-7992",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "220 S Courtenay Pkwy Ste A",
            "address_purpose": "LOCATION",
            "city": "Merritt Island",
            "state": "FL",
            "postal_code": "329524893",
            "country_code": "US",
            "telephone_number": "321-727-7992",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1326 Malabar Rd SE Ste 1",
            "address_purpose": "LOCATION",
            "city": "Palm Bay",
            "state": "FL",
            "postal_code": "329072502",
            "country_code": "US",
            "telephone_number": "321-727-7992",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INDEPENDENT LUNG ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "ST AMAND",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "321-727-7992"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107102000",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269408501",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.