EMERALD COAST AUDIOLOGY PA – Audiologist, NPI 1063521698

EMERALD COAST AUDIOLOGY PA is a healthcare provider. based in Fort walton beach, Florida. specializing in Audiologist. The organization holds a License No. AY1018 (FL). The NPI Number for EMERALD COAST AUDIOLOGY PA is 1063521698

Main info

Organization
Name
EMERALD COAST AUDIOLOGY PA
NPI
1063521698
Phone
(850) 315-4141
Address
11 RACETRACK RD NE STE E4
Authorized Official
CARVER GRAY DETHLOFF OWNER AUD
Enumeration Date
29 August 2006
Last Update Date
21 July 2020
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience62
Completeness75
Years active:19State licenses:1Digital endpointsOther names

Provider Addresses for EMERALD COAST AUDIOLOGY PA

  • 11 RACETRACK RD NE STE E4

    FORT WALTON BEACH, FL 325471867

    Phone: (850) 315-4141

    Fax: (850) 226-8242

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2007-07-17

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2025-07-31 (312 days ago).

Enrollment records

1

Earliest due date

2025-07-31

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20070717000599OClinic/Group PracticeFL2025-07-31

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32547)

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Reviews

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Frequently asked questions

Can I use this page to confirm EMERALD COAST AUDIOLOGY PA's NPI?
Yes. EMERALD COAST AUDIOLOGY PA is listed with NPI 1063521698 in the public NPI dataset.
Can I rely on EMERALD COAST AUDIOLOGY PA being an active provider?
As of the registry snapshot, EMERALD COAST AUDIOLOGY PA is marked active.
What healthcare role does EMERALD COAST AUDIOLOGY PA hold?
Scheduling teams often label EMERALD COAST AUDIOLOGY PA under Audiologist. Clinical services aligned with this taxonomy classification.
Where is EMERALD COAST AUDIOLOGY PA based?
EMERALD COAST AUDIOLOGY PA is tied to Fort Walton Beach, Florida in the data we show; additional addresses may exist on the full record.
Is the information about EMERALD COAST AUDIOLOGY PA up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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