| Southwest Volusia Medical Associates | |
|
1055 Saxon Blvd Orange City FL 32763-8468 | |
| (386) 917-5000 | |
| (386) 917-5848 |
| Full Name | Southwest Volusia Medical Associates |
|---|---|
| Speciality | Internal Medicine |
| Location | 1055 Saxon Blvd, Orange City, Florida |
| Authorized Official Name and Position | Kyle Glass (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3869175017 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Volusia Medical Associates 770 W Granada Blvd Ste 203 Ormond Beach FL 32174-5179 Ph: (386) 231-4252 | Southwest Volusia Medical Associates 1055 Saxon Blvd Orange City FL 32763-8468 Ph: (386) 917-5000 |
| NPI Number | 1902095078 |
|---|---|
| Provider Enumeration Date | 10/15/2007 |
| Last Update Date | 02/26/2021 |
| Medicare PECOS PAC ID | 0446153308 |
|---|---|
| Medicare Enrollment ID | O20040128000953 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902095078 | NPI | - | NPPES |
| 21677 | Other | FL | BCBS FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| Provider Name | Jacob K Agamasu |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1194774604 PECOS PAC ID: 6901701846 Enrollment ID: I20031203000695 |
| Provider Name | Vinny M Varghese |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154370559 PECOS PAC ID: 6204820616 Enrollment ID: I20040409000088 |
| Provider Name | Marielle B Lazard |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1912040197 PECOS PAC ID: 4789670274 Enrollment ID: I20040421000841 |
| Provider Name | Carlos P Grullon |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1427154756 PECOS PAC ID: 3577547934 Enrollment ID: I20040615000495 |
| Provider Name | Wilberto L Lopez |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1275639544 PECOS PAC ID: 7315984788 Enrollment ID: I20050418000113 |
| Provider Name | Martin Gino F Prado |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1487603445 PECOS PAC ID: 7810086121 Enrollment ID: I20080728000261 |
| 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 | Ananth Krishnan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073521902 PECOS PAC ID: 7416003629 Enrollment ID: I20090914000055 |
| Provider Name | Sunita Tikku |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962587139 PECOS PAC ID: 6406824622 Enrollment ID: I20100201000450 |
| Provider Name | Oscar D West |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1548220965 PECOS PAC ID: 3870628886 Enrollment ID: I20100316000776 |
| Provider Name | Anthony P Joseph |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124078530 PECOS PAC ID: 6901098029 Enrollment ID: I20101008000365 |
| Provider Name | Candice Michele Ings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316263486 PECOS PAC ID: 7719160068 Enrollment ID: I20110323000535 |
| Provider Name | Sadrunnisa Hameedi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154427474 PECOS PAC ID: 4688851587 Enrollment ID: I20110601000694 |
| Provider Name | Charlene T Robertson |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1972766954 PECOS PAC ID: 0244418424 Enrollment ID: I20110617000591 |
| Provider Name | David V Joseph |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1952404022 PECOS PAC ID: 3779758065 Enrollment ID: I20111215000229 |
| Provider Name | Samuel M Edwards |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386706000 PECOS PAC ID: 1951577253 Enrollment ID: I20120109000811 |
| Provider Name | Rajendra G Hippalgaonkar |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1265519052 PECOS PAC ID: 8325130362 Enrollment ID: I20120213000246 |
| Provider Name | Lawrence E Vallario |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1710084199 PECOS PAC ID: 3971782459 Enrollment ID: I20120425000697 |
| Provider Name | William J David |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1851497242 PECOS PAC ID: 8426237900 Enrollment ID: I20120514000213 |
| Provider Name | Ratan K Ahuja |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1710945761 PECOS PAC ID: 2365338993 Enrollment ID: I20120712000297 |
| Provider Name | Janak H Bhavsar |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1013995406 PECOS PAC ID: 2769410794 Enrollment ID: I20120803000454 |
| Provider Name | Maria Ana Jeanellee Soriano Co |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1376791798 PECOS PAC ID: 1557592037 Enrollment ID: I20140818000418 |
| Provider Name | Roy P Venzon |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1336333681 PECOS PAC ID: 4385715135 Enrollment ID: I20150622000090 |
| Provider Name | Jacquelynn Witnauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285096321 PECOS PAC ID: 3971892365 Enrollment ID: I20160525002380 |
| Provider Name | Maria Benavidez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609327337 PECOS PAC ID: 7618257023 Enrollment ID: I20161130002235 |
| Provider Name | Cindy B Trawick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598119943 PECOS PAC ID: 8426332669 Enrollment ID: I20170307000768 |
| Provider Name | Maria Morena A Luna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902259625 PECOS PAC ID: 7416234521 Enrollment ID: I20170427000874 |
| Provider Name | Mulugeta Fissha |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1790827715 PECOS PAC ID: 5890963458 Enrollment ID: I20170626000855 |
| Provider Name | Sameer Chadha |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1164736211 PECOS PAC ID: 6103182357 Enrollment ID: I20171104000168 |
| Provider Name | Stacey L Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366922882 PECOS PAC ID: 5799119848 Enrollment ID: I20191223001449 |
| Provider Name | Elisa Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447710157 PECOS PAC ID: 4385072388 Enrollment ID: I20200324003751 |
| Provider Name | Sharanna Sharmel Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538672126 PECOS PAC ID: 0345666459 Enrollment ID: I20200820000316 |
| Provider Name | Shelby Borland Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073107587 PECOS PAC ID: 4789092636 Enrollment ID: I20210414002159 |
| Provider Name | Neethi Paranji |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1568814333 PECOS PAC ID: 5597058461 Enrollment ID: I20220730000255 |
| Provider Name | Kale Meeks |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1891359816 PECOS PAC ID: 4385986579 Enrollment ID: I20230822002963 |
| Provider Name | Andrea Cecilia Alegria Roa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336835503 PECOS PAC ID: 1658734025 Enrollment ID: I20230831004778 |
| Provider Name | Jennifer Glocke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164134607 PECOS PAC ID: 4183095953 Enrollment ID: I20230919003482 |
| Provider Name | Ashraf Jmeian |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1023443074 PECOS PAC ID: 4688997828 Enrollment ID: I20231115003782 |
Primary Care In Your Home Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 341 W Minnesota Ave, Orange City, FL 32763 Phone: 386-316-5439 | |
Genesis Family Practice, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1133 Saxon Blvd, Orange City, FL 32763 Phone: 386-228-9700 | |
Orlando Physicians Network Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2565 Enterprise Rd Ste 300, Orange City, FL 32763 Phone: 386-201-9100 | |
Mediwell Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 921 Town Center Dr, Orange City, FL 32763 Phone: 646-346-4709 | |
Gastroenterology And Liver Diseases Of Central Florida Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2541 S Volusia Ave Ste 300, Orange City, FL 32763 Phone: 386-218-6893 Fax: 386-218-6895 | |
Longleaf Pediatrics Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 103 Birch Ave, Orange City, FL 32763 Phone: 386-532-0800 Fax: 386-532-7005 | |
Ellison Eyecare Ltd. Co Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1039 Harley Strickland Blvd, Orange City, FL 32763 Phone: 386-774-0044 |