NPIMap

Organization Active NPI

Primary Care of Orange City LLC

  • Nurse Practitioner
  • Orange City, FL
National Provider Identifier
1972249530
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
PRIMARY CARE OF ORANGE CITY LLC
Practice address
135 E Minnesota Ave
Orange City, FL 32763-2312
Phone
(386) 316-5439
NPI assigned
May 6, 2022
Organization subpart
Yes
Parent organization
PRIMARY CARE OF ORANGE CITY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

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

Authorized official

Name
John Croker, APRNNPI 1518927763
Title
Ceo
Phone
(386) 473-3553

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
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

135 E Minnesota Ave
Orange City, FL 32763-2312

Mailing address

341 W Minnesota Ave
Orange City, FL 32763-2205
Phone (386) 316-5439

Other names 1

  • Home Wound Care Florida Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jcroker@homedocsfla.com
Direct Messaging Address homedocs@cfl.rr.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220712000357 FL Part B Supplier - Clinic/Group Practice 7517232804 Receives reassigned benefits from 3 practitioners
Practice locations: Orange City, FL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Primary Care of Orange City

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1651795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1972249530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "341 W MINNESOTA AVE",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327632205",
            "telephone_number": "386-316-5439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 E MINNESOTA AVE",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327632312",
            "telephone_number": "386-316-5439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE OF ORANGE CITY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMARY CARE OF ORANGE CITY LLC",
        "enumeration_date": "2022-05-06",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A",
        "authorized_official_last_name": "CROKER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "386-473-3553",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jcroker@homedocsfla.com",
            "affiliation": "N",
            "address_1": "135 E Minnesota Ave",
            "city": "Orange City",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327632312",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "homedocs@cfl.rr.com",
            "affiliation": "N",
            "address_1": "135 E Minnesota Ave",
            "city": "Orange City",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327632312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Home Wound Care Florida",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Home Wound Care Florida",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; 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.