NPIMap

Organization Active NPI

Space Coast Anesthesia Services LLC

  • Anesthesiology Physician
  • Merritt Island, FL
National Provider Identifier
1942441753
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SPACE COAST ANESTHESIA SERVICES LLC
Practice address
595 N Courtenay Pkwy
103
Merritt Island, FL 32953
Phone
(813) 569-6500
Fax
(813) 569-6262
NPI assigned
Mar 9, 2009
Last updated
May 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2021

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

Authorized official

Name
Jeff Parks
Title
Senior Vice President
Phone
(813) 569-6500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

595 N Courtenay Pkwy
103
Merritt Island, FL 32953

Mailing address

4919 Memorial Hwy Ste 200
Tampa, FL 33634-7500
Phone (239) 610-0775

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090611000695 FL Part B Supplier - Clinic/Group Practice 5496805426 Receives reassigned benefits from 100 practitioners
Practice locations: Merritt Island, FL; Ormond Beach, FL

National Provider Directory

National Provider Directory

Member of 1

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

Locations

1545 Hand Ave
Ste A2
Ormond Beach, FL 32174
Phone (386) 457-7114

Practitioners & affiliated clinicians

Practitioners 105

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 105

NPI Registry JSON

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

{
    "created_epoch": "1236556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621900800000",
    "number": "1942441753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4919 MEMORIAL HWY STE 200",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336347500",
            "telephone_number": "239-610-0775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 N COURTENAY PKWY",
            "address_2": "103",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "32953",
            "telephone_number": "813-569-6500",
            "fax_number": "813-569-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST ANESTHESIA SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-09",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "813-569-6500"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; 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.