| Adventhealth Medical Group | |
|
305 Memorial Medical Pkwy Ste 205 Daytona Beach FL 32117-5169 | |
| (386) 231-3530 | |
| Not Available |
| Full Name | Adventhealth Medical Group |
|---|---|
| Speciality | Surgery |
| Location | 305 Memorial Medical Pkwy Ste 205, Daytona Beach, Florida |
| Authorized Official Name and Position | Cory Domayer (CFO) |
| Authorized Official Contact | 3862313906 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adventhealth Medical Group 770 W Granada Blvd Ste 203 Ormond Beach FL 32174-5179 Ph: (863) 231-4252 | Adventhealth Medical Group 305 Memorial Medical Pkwy Ste 205 Daytona Beach FL 32117-5169 Ph: (386) 231-3530 |
| NPI Number | 1922115914 |
|---|---|
| Provider Enumeration Date | 08/24/2006 |
| Last Update Date | 04/28/2022 |
| Medicare PECOS PAC ID | 9739081142 |
|---|---|
| Medicare Enrollment ID | O20040730000409 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922115914 | NPI | - | NPPES |
| 40181J | Other | FL | MEDICARE ID UNSPECIFIED |
| Provider Name | Arthur W Wilkinson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1396719571 PECOS PAC ID: 4880669787 Enrollment ID: I20040901001120 |
| Provider Name | David L Meese |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1235131962 PECOS PAC ID: 3678534609 Enrollment ID: I20041022001009 |
| Provider Name | Federico C Vinas |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1184601304 PECOS PAC ID: 5395708960 Enrollment ID: I20041105000230 |
| Provider Name | Patrick Terry Mangonon |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1023067584 PECOS PAC ID: 1759328461 Enrollment ID: I20050414000293 |
| Provider Name | Christian L Birkedal |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1043205404 PECOS PAC ID: 0840228797 Enrollment ID: I20050801001109 |
| Provider Name | Julie D Schneider |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1720001852 PECOS PAC ID: 6002911211 Enrollment ID: I20070417000537 |
| Provider Name | Cecille A Tapia-santiago |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1386693877 PECOS PAC ID: 0244229508 Enrollment ID: I20070709000519 |
| Provider Name | Meetesh S Desai |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1346290145 PECOS PAC ID: 2567554744 Enrollment ID: I20070817000018 |
| Provider Name | Ashraf S Elsakr |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1184627390 PECOS PAC ID: 1658368667 Enrollment ID: I20070904000555 |
| Provider Name | Dennis M Murphy |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1992704522 PECOS PAC ID: 4082717376 Enrollment ID: I20070915000109 |
| Provider Name | Utpal Sureskumar Desai |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1760478101 PECOS PAC ID: 9234225590 Enrollment ID: I20071017000798 |
| Provider Name | Sergio J Vignali |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1417085309 PECOS PAC ID: 8729160395 Enrollment ID: I20080205000237 |
| Provider Name | Shawn W Thomas |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1043416506 PECOS PAC ID: 8921173923 Enrollment ID: I20080826000136 |
| Provider Name | Mark Riner |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1275521221 PECOS PAC ID: 5991872129 Enrollment ID: I20080930000200 |
| Provider Name | Andrew H Ritter |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1447252432 PECOS PAC ID: 3678599818 Enrollment ID: I20081202000905 |
| Provider Name | Vinayak V Purandare |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1265429500 PECOS PAC ID: 7517982465 Enrollment ID: I20090127000416 |
| Provider Name | Chad L Broome-webster |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1669430732 PECOS PAC ID: 6204992886 Enrollment ID: I20090305000601 |
| Provider Name | John T Tolland |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1750383733 PECOS PAC ID: 6305862541 Enrollment ID: I20090515000469 |
| Provider Name | Bennett P Scaglia |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1003880626 PECOS PAC ID: 3274600911 Enrollment ID: I20090529000304 |
| Provider Name | Gregory James Velat |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1417031691 PECOS PAC ID: 2769534262 Enrollment ID: I20090714000683 |
| Provider Name | Sureskumar D Desai |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1821181090 PECOS PAC ID: 5890820047 Enrollment ID: I20100315000013 |
| Provider Name | Ted E Robertson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1609849496 PECOS PAC ID: 7517141609 Enrollment ID: I20110414000444 |
| Provider Name | Allison L Mcnamara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043593197 PECOS PAC ID: 3173778156 Enrollment ID: I20130222000280 |
| Provider Name | Brittany Nicole Lawson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275948754 PECOS PAC ID: 8820310378 Enrollment ID: I20141211001176 |
| Provider Name | Cary Howard Meyers |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1851329833 PECOS PAC ID: 5890699979 Enrollment ID: I20150218000410 |
| Provider Name | Prathap Kumar Simhadri |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1548410574 PECOS PAC ID: 3173767969 Enrollment ID: I20150223001025 |
| Provider Name | Christopher Grove |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1306838545 PECOS PAC ID: 8426082173 Enrollment ID: I20151123001478 |
| Provider Name | Sarah E Barbel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912355140 PECOS PAC ID: 7618262106 Enrollment ID: I20160823001630 |
| Provider Name | Taylor P Unger |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1366893984 PECOS PAC ID: 5890076848 Enrollment ID: I20170105000677 |
| Provider Name | Cindy B Trawick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598119943 PECOS PAC ID: 8426332669 Enrollment ID: I20170307000768 |
| Provider Name | Benjamin Lindbloom |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1699065128 PECOS PAC ID: 0446521744 Enrollment ID: I20170804001374 |
| Provider Name | Cloressa Marie Dizney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023558988 PECOS PAC ID: 2567714488 Enrollment ID: I20181003003870 |
| Provider Name | Margaret Christine Trope |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467938472 PECOS PAC ID: 9133471824 Enrollment ID: I20181008001998 |
| Provider Name | Jason T Nieves |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1194088369 PECOS PAC ID: 2961749353 Enrollment ID: I20190123001908 |
| Provider Name | Gregory B Burgoyne |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659534063 PECOS PAC ID: 1850531013 Enrollment ID: I20190205000357 |
| Provider Name | Jennifer Bottke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720575145 PECOS PAC ID: 7911247309 Enrollment ID: I20190321001524 |
| Provider Name | Erinc Akture |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1417213513 PECOS PAC ID: 5698076057 Enrollment ID: I20190731000361 |
| Provider Name | Miranda Leigh Pelzel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639607070 PECOS PAC ID: 1254668361 Enrollment ID: I20190813001564 |
| Provider Name | Sherica A. Shapaka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013015577 PECOS PAC ID: 9133186018 Enrollment ID: I20190829001005 |
| Provider Name | Susan Stovall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851727069 PECOS PAC ID: 6800962226 Enrollment ID: I20200210000094 |
| Provider Name | Mark Richard Zunkiewicz |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1104077064 PECOS PAC ID: 6709931553 Enrollment ID: I20200507001262 |
| Provider Name | Alexis Ann Cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073030573 PECOS PAC ID: 7719238591 Enrollment ID: I20200512002858 |
| Provider Name | Katherine Dinan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487285953 PECOS PAC ID: 3375965049 Enrollment ID: I20200625001687 |
| Provider Name | Willythssa Pierre-louis |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1265828032 PECOS PAC ID: 7416269683 Enrollment ID: I20200702001286 |
| Provider Name | Zoe S Griffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588280325 PECOS PAC ID: 2567889892 Enrollment ID: I20200901000585 |
| Provider Name | James Edward Collie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790385029 PECOS PAC ID: 7517378243 Enrollment ID: I20201201001169 |
| Provider Name | Andres Santiago Endara Bravo |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1972795599 PECOS PAC ID: 5698917110 Enrollment ID: I20201214000148 |
| Provider Name | Muhammed Sherid |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1700176088 PECOS PAC ID: 7810166949 Enrollment ID: I20210311000681 |
| Provider Name | Jesna Sublett |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1639460827 PECOS PAC ID: 6709181274 Enrollment ID: I20210524000422 |
| Provider Name | Sherriann Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710577705 PECOS PAC ID: 2567876741 Enrollment ID: I20210524001951 |
| Provider Name | Nancy Butler |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1770522377 PECOS PAC ID: 6305825068 Enrollment ID: I20210623000756 |
| Provider Name | Valerie Marie Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306220108 PECOS PAC ID: 4284043605 Enrollment ID: I20210623001661 |
| Provider Name | Wissam Mohamed Elfallal |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1730594805 PECOS PAC ID: 1153723846 Enrollment ID: I20210719000979 |
| Provider Name | Ravi Varma Dhanisetty |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1427201359 PECOS PAC ID: 0345494175 Enrollment ID: I20211109003571 |
| Provider Name | Cassie Marie Sciotto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760135875 PECOS PAC ID: 1052706744 Enrollment ID: I20220316000338 |
| Provider Name | Sarah Ann Bionelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679221105 PECOS PAC ID: 0143616862 Enrollment ID: I20220406001006 |
| Provider Name | Ashley Suzanne Pease |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326610544 PECOS PAC ID: 3779979141 Enrollment ID: I20220412001264 |
| Provider Name | Chloe Louise Kindred |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790348191 PECOS PAC ID: 6507108792 Enrollment ID: I20220607002210 |
| Provider Name | Vijay Mahadev Pandav |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1295046084 PECOS PAC ID: 6103065578 Enrollment ID: I20220803004068 |
| Provider Name | Ron Rosenberg |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1598253825 PECOS PAC ID: 8325420581 Enrollment ID: I20220804000567 |
| Provider Name | Mathew David Quattrocelli |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1447769864 PECOS PAC ID: 8325436199 Enrollment ID: I20220804000967 |
| Provider Name | Marcus Magidow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376274654 PECOS PAC ID: 1052794914 Enrollment ID: I20220810002651 |
| Provider Name | Nathaniel Osborn |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1528412236 PECOS PAC ID: 2668711029 Enrollment ID: I20221010001496 |
| Provider Name | Suzan Michelle De Feo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568169274 PECOS PAC ID: 2264805548 Enrollment ID: I20230307003078 |
| Provider Name | Gary Fishman |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1831138304 PECOS PAC ID: 9537124250 Enrollment ID: I20230406000515 |
| Provider Name | Harry Truman Aubin |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1386906782 PECOS PAC ID: 3971913005 Enrollment ID: I20230421002146 |
| Provider Name | Crystal Dawn Geiger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225728272 PECOS PAC ID: 2062872112 Enrollment ID: I20230720002131 |
| Provider Name | Matthew Ryan Wilson |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1316006083 PECOS PAC ID: 2062644370 Enrollment ID: I20230817002366 |
| Provider Name | Ronnie J Hoelker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811319908 PECOS PAC ID: 9931322955 Enrollment ID: I20230822000665 |
| Provider Name | Ross Myers Hempel |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1235660523 PECOS PAC ID: 8022471945 Enrollment ID: I20230824004314 |
| Provider Name | Andrew Edward Everett |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1134581283 PECOS PAC ID: 1456764869 Enrollment ID: I20231004002192 |
| Provider Name | Jaclyn Marie Mignella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124582085 PECOS PAC ID: 2961850326 Enrollment ID: I20231122002397 |
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