NPIMap

Organization Active NPI

Marathon Health, LLC

  • General Practice Physician
  • Titusville, FL
National Provider Identifier
1942740675
Registry record updated Feb 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MARATHON HEALTH, LLC
Practice address
1505 Knox McRae Drive
C/O Brevard Wellcare- North
Titusville, FL 32780
Phone
(802) 857-0400
NPI assigned
Feb 28, 2017
Last updated
Feb 28, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
MARATHON HEALTH, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 28, 2017

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

Authorized official

Name
Jerry Ford
Title
Ceo
Phone
(802) 857-0400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

1505 Knox McRae Drive
C/O Brevard Wellcare- North
Titusville, FL 32780

Mailing address

20 Winooski Falls Way
Ste. 400
Winooski, VT 05404-2228
Phone (802) 857-0400

Other names 1

  • Marathon Health at Brevard North Other name

National Provider Directory

National Provider Directory
Tax ID family
Marathon Health Inc166 organizations share this tax ID, including this one
Part of
Marathon Health Inc

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Practitioners & affiliated clinicians

Practitioners 1

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": "1488240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1942740675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 WINOOSKI FALLS WAY",
            "address_2": "STE. 400",
            "city": "WINOOSKI",
            "state": "VT",
            "postal_code": "054042228",
            "telephone_number": "802-857-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 KNOX MCRAE DRIVE",
            "address_2": "C/O BREVARD WELLCARE- NORTH",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "32780",
            "telephone_number": "802-857-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARATHON HEALTH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARATHON HEALTH, LLC",
        "enumeration_date": "2017-02-28",
        "last_updated": "2017-02-28",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "802-857-0400"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marathon Health at Brevard North",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Titusville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.