Community Medical Center of West Volusia PA

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

COMMUNITY MEDICAL CENTER OF WEST VOLUSIA PA

Practice address

810 Commed Blvd
Orange City, FL 32763-8322

Phone

(386) 775-1792

Fax

(386) 775-1750

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Marcelo R. Anayas, M.D.

Title

Medical Director

Phone

(386) 738-1792

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Rural health clinic certification: CCN 103897

Legal name

COMMUNITY MEDICAL CENTER OF WEST VOLUSIA PA

Doing business as

COMMUNITY MEDICAL CENTER

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jan 25, 1995

Last certification

Nov 7, 2023

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Jul 28, 2008 in FL

Enrollment address

810 Commed Blvd
Orange City, FL 32763-8322

Other NPIs with the same Medicare PAC ID 1

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

• Community Medical Center of West Volusia PA

  • Rural Health Clinic/Center
  • Deland, FL
  • NPI 1861579104

  3870630676

  Same PAC ID

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Community Medical Center of West Volusia PA

  • Rural Health Clinic/Center
  • Deland, FL
  • NPI 1861579104

  Operational/Managerial Control

  CMS ownership

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440460800000",
    "number": "1992882245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 COMMED BLVD",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638322",
            "telephone_number": "386-775-1792",
            "fax_number": "386-775-1750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 COMMED BLVD",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638322",
            "telephone_number": "386-775-1792",
            "fax_number": "386-775-1750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL CENTER OF WEST VOLUSIA PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2015-08-25",
        "status": "A",
        "authorized_official_last_name": "ANAYAS",
        "authorized_official_first_name": "MARCELO",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "386-738-1792",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660026302",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rural Health Clinic/Center in Orange City, FL
• Providers in Orange City, FL by specialty
• Rural Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.