NPIMap

Organization Active NPI

Community Medical Center of West Volusia PA

  • Rural Health Clinic/Center
  • Orange City, FL
National Provider Identifier
1992882245
Registry record updated Aug 25, 2015
On this page

Key facts

NPPES NPI Registry
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
Last updated
Aug 25, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2015

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.NPI 1114001559
Title
Medical Director
Phone
(386) 738-1792

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

810 Commed Blvd
Orange City, FL 32763-8322

Mailing address

810 Commed Blvd
Orange City, FL 32763-8322
Phone (386) 775-1792

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091028000571 FL Part A Provider - Rural Health Clinic 3870630676 Practice locations: Orange City, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992882245. Details of each certification follow.

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).

National Provider Directory

National Provider Directory

Ownership & related parties

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.

NameRoleSinceShare
Marcelo Anayas Individual 5% Or Greater Direct Ownership InterestMedical Director Jul 28, 2009 50%
Marc Anayas Individual W-2 Managing EmployeeAd; Jan 1, 2005
Concepcion Anayas Individual 5% Or Greater Direct Ownership InterestPediatric Medical Director Sep 1, 1987 50%

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Community Medical CenterDeland, FL, CCN 103869 Rural health clinic Operational/Managerial Control Jul 24, 1994

Owned or controlled facilities with NPI records 1

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

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": "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange City, FL

Sources for this page

Verify at the official NPI Registry.