| Harris Family Medical Center | |
|
1800 W Hibiscus Blvd Ste 101 Melbourne FL 32901-2624 | |
| (321) 726-1600 | |
| (321) 726-1610 |
| Full Name | Harris Family Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1800 W Hibiscus Blvd Ste 101, Melbourne, Florida |
| Authorized Official Name and Position | Lynn Sprunger (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 3217261609 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Harris Family Medical Center 1800 W Hibiscus Blvd Ste 101 Melbourne FL 32901-2624 Ph: (321) 726-1600 | Harris Family Medical Center 1800 W Hibiscus Blvd Ste 101 Melbourne FL 32901-2624 Ph: (321) 726-1600 |
| NPI Number | 1104947217 |
|---|---|
| Provider Enumeration Date | 04/03/2007 |
| Last Update Date | 08/25/2008 |
| Medicare PECOS PAC ID | 1658265079 |
|---|---|
| Medicare Enrollment ID | O20040209000360 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104947217 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Richard J Lichtenstein |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770522278 PECOS PAC ID: 3577464387 Enrollment ID: I20040115000559 |
| Provider Name | Mark Paul Preston |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396729810 PECOS PAC ID: 2567365372 Enrollment ID: I20040129000570 |
| Provider Name | Pervez A Siddiqui |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477533396 PECOS PAC ID: 7012805484 Enrollment ID: I20040308000681 |
| Provider Name | Jeffrey R Wasserman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1437104676 PECOS PAC ID: 5294725941 Enrollment ID: I20040514000350 |
| Provider Name | Jeffrey Araj |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1679549059 PECOS PAC ID: 1153304134 Enrollment ID: I20040610001176 |
| Provider Name | Hugo J Montes |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1225084189 PECOS PAC ID: 7911987771 Enrollment ID: I20040722000388 |
| Provider Name | David A Picca |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043279433 PECOS PAC ID: 1951361971 Enrollment ID: I20041014000325 |
| Provider Name | Shawn R Meader |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1780655134 PECOS PAC ID: 9133181431 Enrollment ID: I20041029000220 |
| Provider Name | Samuel A Shube |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902859457 PECOS PAC ID: 0941243711 Enrollment ID: I20050603000116 |
| Provider Name | Ajay Pancholy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144289539 PECOS PAC ID: 2062472384 Enrollment ID: I20050709000002 |
| Provider Name | Steven M Tidwell |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1538149216 PECOS PAC ID: 2062444581 Enrollment ID: I20050907000233 |
| Provider Name | Gerald M Klein |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689653438 PECOS PAC ID: 2365484110 Enrollment ID: I20050908001080 |
| Provider Name | George Antaki |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1962479964 PECOS PAC ID: 6901797844 Enrollment ID: I20050915000635 |
| Provider Name | Steven D Picerne |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1124046339 PECOS PAC ID: 5991729733 Enrollment ID: I20060324000604 |
| Provider Name | Lewis C Bean |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1417938382 PECOS PAC ID: 1456310309 Enrollment ID: I20061025000021 |
| Provider Name | Robert Andrew Zamore |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588623979 PECOS PAC ID: 5496753816 Enrollment ID: I20061120000256 |
| Provider Name | David J Germain |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881653269 PECOS PAC ID: 3274531694 Enrollment ID: I20061120000287 |
| Provider Name | Claude B Guidi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790744183 PECOS PAC ID: 3274538475 Enrollment ID: I20070112000016 |
| Provider Name | Douglas Rodriguez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1124087515 PECOS PAC ID: 6709881907 Enrollment ID: I20070112000018 |
| Provider Name | Bharatkumar U Patel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1912966318 PECOS PAC ID: 0042107104 Enrollment ID: I20070112000020 |
| Provider Name | Gregg A Baran |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104885573 PECOS PAC ID: 6103821301 Enrollment ID: I20070112000021 |
| Provider Name | Scott R Anderson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1225098205 PECOS PAC ID: 5294730495 Enrollment ID: I20070607000696 |
| Provider Name | Marilin Francisca Espino-maya |
|---|---|
| Provider Type | Practitioner - Nuclear Medicine |
| Provider Identifiers | NPI Number: 1659330033 PECOS PAC ID: 2567467764 Enrollment ID: I20070718000503 |
| Provider Name | Jose M Negron-soto |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083635437 PECOS PAC ID: 9133123839 Enrollment ID: I20070808000784 |
| Provider Name | Clifford R Davis |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1376632521 PECOS PAC ID: 4183717598 Enrollment ID: I20070830000389 |
| Provider Name | Inbal Cohen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1457572216 PECOS PAC ID: 3577656883 Enrollment ID: I20070831000472 |
| Provider Name | Laurence Shane Grundy |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1649239054 PECOS PAC ID: 0648275842 Enrollment ID: I20070924000357 |
| Provider Name | Rajendra P Kedar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1336108729 PECOS PAC ID: 7810992013 Enrollment ID: I20071214000285 |
| Provider Name | Ryan Murtagh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548396997 PECOS PAC ID: 3678663127 Enrollment ID: I20071220000283 |
| Provider Name | Hemant D Chheda |
|---|---|
| Provider Type | Practitioner - Nuclear Medicine |
| Provider Identifiers | NPI Number: 1053370437 PECOS PAC ID: 0749285948 Enrollment ID: I20080107000212 |
| Provider Name | Leelakrishna Nallamshetty |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1427197060 PECOS PAC ID: 3072613074 Enrollment ID: I20080724000767 |
| Provider Name | Neelesh S Prakash |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861698375 PECOS PAC ID: 5092815639 Enrollment ID: I20080801000608 |
| Provider Name | Bret Neiderman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396958872 PECOS PAC ID: 5799875670 Enrollment ID: I20081029000573 |
| Provider Name | Katie J Lester |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1093804205 PECOS PAC ID: 5294899936 Enrollment ID: I20090126000281 |
| Provider Name | Alexander Le |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881866101 PECOS PAC ID: 0042375248 Enrollment ID: I20090713000570 |
| Provider Name | Bryant Thorpe |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295730877 PECOS PAC ID: 8921076225 Enrollment ID: I20091021000664 |
| Provider Name | Todd R Kumm |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104075043 PECOS PAC ID: 0941342000 Enrollment ID: I20100127000771 |
| Provider Name | Nisha Rao |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063607216 PECOS PAC ID: 0042380107 Enrollment ID: I20100709000784 |
| Provider Name | David Pocoski |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1235194754 PECOS PAC ID: 2062545924 Enrollment ID: I20100729000734 |
| Provider Name | John C Feldman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801985072 PECOS PAC ID: 6305960675 Enrollment ID: I20100824000844 |
| Provider Name | Concetta Giuliano |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881657070 PECOS PAC ID: 9931397775 Enrollment ID: I20101221000843 |
| Provider Name | Joann Gierbolini |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1942499074 PECOS PAC ID: 5991993313 Enrollment ID: I20101228001028 |
| Provider Name | Juan Lee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205836699 PECOS PAC ID: 3476547670 Enrollment ID: I20110502000759 |
| Provider Name | Ashley B Maru |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1942370580 PECOS PAC ID: 2264515030 Enrollment ID: I20110712000277 |
| Provider Name | David Huang |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1336374305 PECOS PAC ID: 0547312647 Enrollment ID: I20110713000419 |
| Provider Name | Sandra L Armstrong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003109661 PECOS PAC ID: 9537338579 Enrollment ID: I20110809000705 |
| Provider Name | Joshua Marion Blackmon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1750599742 PECOS PAC ID: 7113197484 Enrollment ID: I20110823000915 |
| Provider Name | Marc Camacho |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1912932005 PECOS PAC ID: 0244227734 Enrollment ID: I20111227000556 |
| Provider Name | Joseph Freedman |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1801061890 PECOS PAC ID: 8325209307 Enrollment ID: I20120418000777 |
| Provider Name | Alan Marumoto |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1710902812 PECOS PAC ID: 8123280393 Enrollment ID: I20120504000153 |
| Provider Name | Susan F Haines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992079701 PECOS PAC ID: 0345403291 Enrollment ID: I20120514000184 |
| Provider Name | Ryan M Harvey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1982864542 PECOS PAC ID: 1153544606 Enrollment ID: I20140602001000 |
| Provider Name | Gus Mitsopoulos |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1750669032 PECOS PAC ID: 4880810985 Enrollment ID: I20140725001819 |
| Provider Name | Jasmin Harvey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1982896452 PECOS PAC ID: 6709026115 Enrollment ID: I20140731001907 |
| Provider Name | Douglas P Ivancsits |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1437390390 PECOS PAC ID: 0042531543 Enrollment ID: I20150609002766 |
| Provider Name | Glenn A Hoots |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1477873750 PECOS PAC ID: 1254624414 Enrollment ID: I20160726000523 |
| Provider Name | Travis Cron Foster |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205128568 PECOS PAC ID: 3870743503 Enrollment ID: I20170623002079 |
| Provider Name | Kelly Elizabeth Fabrega-foster |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275826802 PECOS PAC ID: 1850521667 Enrollment ID: I20170706002043 |
| Provider Name | Edward Oif |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1730384447 PECOS PAC ID: 2961625637 Enrollment ID: I20171226001722 |
| Provider Name | Mark J. Rieumont |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1881689487 PECOS PAC ID: 9638130024 Enrollment ID: I20180118000838 |
| Provider Name | Hadi Bazzi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457615221 PECOS PAC ID: 1951621549 Enrollment ID: I20180219000542 |
| Provider Name | Scott A Drummond |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1962552604 PECOS PAC ID: 2163783531 Enrollment ID: I20180531001253 |
| Provider Name | Lloyd D Wagner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1124161872 PECOS PAC ID: 3870517923 Enrollment ID: I20181029001815 |
| Provider Name | Fernando Vilela Viana |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447750419 PECOS PAC ID: 9234471483 Enrollment ID: I20190508002517 |
| Provider Name | Chad Engel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1386986958 PECOS PAC ID: 0446585947 Enrollment ID: I20190703002329 |
| Provider Name | Ghizlane Bouzghar Bahij |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1750649679 PECOS PAC ID: 4587913595 Enrollment ID: I20190718002734 |
| Provider Name | Eric M. Tirnauer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1336467059 PECOS PAC ID: 7416267836 Enrollment ID: I20190926001891 |
| Provider Name | Saba Y Khan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1982044285 PECOS PAC ID: 0345598926 Enrollment ID: I20191111000138 |
| Provider Name | Frank R Graybeal |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073615068 PECOS PAC ID: 6103892856 Enrollment ID: I20191119003280 |
| Provider Name | Billy Blackmon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1215058110 PECOS PAC ID: 4284758061 Enrollment ID: I20200131001171 |
| Provider Name | Reuben Nicholas Trane |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417913427 PECOS PAC ID: 8325032220 Enrollment ID: I20200207001694 |
| Provider Name | Mamdouh E Rayan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134261845 PECOS PAC ID: 3274434543 Enrollment ID: I20200327002011 |
| Provider Name | Irina S Gruzinova |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902285240 PECOS PAC ID: 8628355435 Enrollment ID: I20200730001254 |
| Provider Name | Timothy G Zelenak |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376746461 PECOS PAC ID: 5698931244 Enrollment ID: I20200911000796 |
| Provider Name | Rajiv Verma |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1659532174 PECOS PAC ID: 9234299983 Enrollment ID: I20201109000034 |
| Provider Name | Hristina N Natcheva |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1184942286 PECOS PAC ID: 4284947219 Enrollment ID: I20210216002998 |
| Provider Name | Frank Fayz |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104856145 PECOS PAC ID: 7315841475 Enrollment ID: I20210820000470 |
| Provider Name | Baruch Meer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639410301 PECOS PAC ID: 5395030175 Enrollment ID: I20210915002754 |
| Provider Name | Matthew E Brice |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992064406 PECOS PAC ID: 4486877966 Enrollment ID: I20220323000361 |
| Provider Name | Steven Rinehouse |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265428908 PECOS PAC ID: 0840276499 Enrollment ID: I20220428001228 |
| Provider Name | Aamer Farooki |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316941859 PECOS PAC ID: 5698768539 Enrollment ID: I20221027002376 |
| Provider Name | Sudha Challa |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1386646727 PECOS PAC ID: 1153313614 Enrollment ID: I20230510003122 |
| Provider Name | Shingo Kihira |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134652753 PECOS PAC ID: 2062752447 Enrollment ID: I20230727002476 |
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