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2428 Clearlake Rd Bldg K Cocoa FL 32922-5722 | |
| (321) 368-3862 | |
| (321) 208-8717 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 2428 Clearlake Rd Bldg K, Cocoa, Florida |
| Authorized Official Name and Position | Srinivas Rao Dontineni (INTERNAL MEDICINE PHYSICIAN) |
| Authorized Official Contact | 3217519506 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 560059 Rockledge FL 32956-0059 Ph: (321) 368-3862 | 2428 Clearlake Rd Bldg K Cocoa FL 32922-5722 Ph: (321) 368-3862 |
| NPI Number | 1639323041 |
|---|---|
| Provider Enumeration Date | 11/12/2008 |
| Last Update Date | 01/28/2025 |
| Medicare PECOS PAC ID | 3375600612 |
|---|---|
| Medicare Enrollment ID | O20090331000553 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639323041 | NPI | - | NPPES |
| 004793700 | Medicaid | FL | |
| BM919A | Other | FL | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Srinivas R Dontineni |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1669467155 PECOS PAC ID: 5092614891 Enrollment ID: I20031231000098 |
| Provider Name | Chandra S Pingili |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063734069 PECOS PAC ID: 7517093347 Enrollment ID: I20100331000092 |
| Provider Name | Pushpa Chand Daliya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841761673 PECOS PAC ID: 6204162779 Enrollment ID: I20190723000980 |
| Provider Name | Brandon T Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356974588 PECOS PAC ID: 0840614467 Enrollment ID: I20200715003126 |
| Provider Name | Kellie L Herrington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891313334 PECOS PAC ID: 4587080882 Enrollment ID: I20200818000489 |
| Provider Name | Shanelly Rivas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447919030 PECOS PAC ID: 7517354103 Enrollment ID: I20220429000534 |
| Provider Name | Samantha Kossman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033948633 PECOS PAC ID: 8628500568 Enrollment ID: I20241016001575 |
Ana Conde Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2428 Clearlake Rd Bldg K, Cocoa, FL 32922 Phone: 321-368-3862 | |
Ricardo Antonio Henriques M.d. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 503 Delannoy Ave, Cocoa, FL 32922 Phone: 321-631-6995 Fax: 321-633-1004 | |
Steward Medical Group, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1317 W Point Dr, Cocoa, FL 32922 Phone: 615-467-4158 Fax: 615-467-1267 | |
Miracle Pain Relief Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 234 Willard St Ste C, Cocoa, FL 32922 Phone: 321-477-2273 | |
Rameshwar N Mathur Md Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6250 N Us 1, Cocoa, FL 32927 Phone: 321-631-6402 Fax: 321-633-7041 |