NPIMap

Organization Active NPI

Samuel D. Critides, Jr., M.D., P.a.

Doing business as Homeport Neurosurgery and Spine

  • Neurological Surgery Physician
  • Fort Walton Beach, FL
National Provider Identifier
1932887676
Registry record updated Apr 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
SAMUEL D. CRITIDES, JR., M.D., P.A.
Doing business as
Homeport Neurosurgery and Spine
Practice address
350G Racetrack Rd NW
Fort Walton Beach, FL 32547-1699
Phone
(850) 374-3125
Fax
(850) 226-5544
NPI assigned
Jul 11, 2023
Last updated
Apr 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2026

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

Authorized official

Name
Samuel D Critides Jr., MDNPI 1902856503
Title
Owner/ P, S
Phone
(850) 374-3125

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Neurological Surgery Physician 207T00000X NU Primary

Addresses

Primary practice location

350G Racetrack Rd NW
Fort Walton Beach, FL 32547-1699

Mailing address

350G Racetrack Rd NW
Fort Walton Beach, FL 32547-1699
Phone (850) 374-3125

Other names 1

  • HOMEPORT NEUROSURGERY AND SPINE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230804001317 FL Part B Supplier - Clinic/Group Practice 1759742877 Receives reassigned benefits from 4 practitioners
Practice locations: Fort Walton Beach, FL
O20240502000547 FL DME Supplier - Physician - Neurosurgery 1759742877 Practice locations: Fort Walton Beach, FL

National Provider Directory

National Provider Directory

Locations

350G Racetrack Rd NW
Ft Walton Bch, FL 32547
Phone (850) 374-3125

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1689033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775001600000",
    "number": "1932887676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350G RACETRACK RD NW",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471699",
            "telephone_number": "850-374-3125",
            "fax_number": "850-226-5544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350G RACETRACK RD NW",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471699",
            "telephone_number": "850-374-3125",
            "fax_number": "850-226-5544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL D. CRITIDES, JR., M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-11",
        "last_updated": "2026-04-01",
        "certification_date": "2026-04-01",
        "status": "A",
        "authorized_official_last_name": "CRITIDES",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/ P, S",
        "authorized_official_telephone_number": "850-374-3125",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HOMEPORT NEUROSURGERY AND SPINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2026; 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.