ORTHOPAEDIC CLINIC OF DAYTONA BEACH PA – Orthopaedic Surgery Physician, NPI 1558340240
Orthopaedic Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for ORTHOPAEDIC CLINIC OF DAYTONA BEACH PA
1165 Dunlawton Ave Ste 102
Port Orange, FL 321272924
Phone: (386) 255-4596
Fax: (386) 258-3561
Type: Location
1075, Mason Avenue, Daytona Beach, Volusia County, Florida, 32117, United States
DAYTONA BEACH, FL 321174611
Phone: (386) 255-4596
Fax: (386) 258-3561
Type: Mailing
17 Old Kings Rd N Ste K
Palm Coast, FL 321378283
Phone: (386) 255-4596
Fax: (386) 258-3561
Type: Location
1175 Dunlawton Ave Ste 1
Port Orange, FL 321274741
Phone: (386) 255-4596
Fax: (386) 258-3561
Type: Location
1890 Lpga Blvd Ste 240
Daytona Beach, FL 321177131
Phone: (386) 255-4596
Fax: (386) 258-3561
Type: Location
1865 LPGA BLVD
DAYTONA BEACH, FL 321177108
Phone: (386) 255-4596
Fax: (386) 258-3561
Type: Mailing
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: 2010-09-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation due soon
Earliest CMS due date is 2026-06-30 (21 days away).
Enrollment records
2
Earliest due date
2026-06-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040615001416 | O | Clinic/Group Practice | FL | TBD |
| O20100930044859 | O | Physician - Orthopedic/Orthopedic Surgery | FL | 2026-06-30 |
What to do next
- Confirm the due date on the CMS Revalidation Lookup Tool.
- Complete revalidation in PECOS before the published due date.
- If you have multiple enrollment records, revalidate each one on its own schedule.
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 32127)
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