AdventHealth Medical Group – Surgery Physician, NPI 1922115914
Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for AdventHealth Medical Group
335 Clyde Morris Blvd Ste 240
Ormond Beach, FL 321743197
Phone: (386) 231-3561
Type: Location
5535 S Williamson Blvd Ste 700
Port Orange, FL 321288321
Phone: (386) 231-6300
Type: Location
290 Clyde Morris Blvd Ste A2
Ormond Beach, FL 321748204
Phone: (386) 231-3490
Type: Location
305 Memorial Medical Pkwy Ste 207
Daytona Beach, FL 321175169
Phone: (386) 231-3525
Type: Location
305 Memorial Medical Pkwy Ste 307
Daytona Beach, FL 321175169
Phone: (386) 231-3512
Type: Location
305 Memorial Medical Pkwy Ste 308
Daytona Beach, FL 321175137
Phone: (386) 231-3602
Type: Location
305 Memorial Medical Pkwy Ste 400
Daytona Beach, FL 321175169
Phone: (386) 231-3580
Type: Location
305 Memorial Medical Pkwy Ste 401
Daytona Beach, FL 321175169
Phone: (386) 231-3612
Type: Location
301 Memorial Medical Pkwy
Daytona Beach, FL 321175167
Phone: (386) 231-6000
Type: Location
1893 N Clyde Morris Blvd Ste 100
Daytona Beach, FL 321175536
Phone: (386) 677-0531
Type: Location
1050 W Granada Blvd Ste 2A
Ormond Beach, FL 321748155
Phone: (386) 231-3050
Type: Location
1890 Lpga Blvd Ste 170
Daytona Beach, FL 321177131
Phone: (386) 274-3354
Type: Location
305 Memorial Medical Pkwy Ste 201
Daytona Beach, FL 321175169
Phone: (386) 231-3530
Type: Location
305 Memorial Medical Pkwy Ste 209
Daytona Beach, FL 321175169
Phone: (386) 231-3520
Type: Location
305 Memorial Medical Pkwy Ste 208
Daytona Beach, FL 321175169
Phone: (386) 231-3593
Fax: (386) 672-9904
Type: Location
305 MEMORIAL MEDICAL PKWY STE 205
DAYTONA BEACH, FL 321175169
Phone: (386) 231-3530
Type: Location
203, Granada Boulevard, Ormond Beach, Volusia County, Florida, 32174, United States
ORMOND BEACH, FL 321745179
Phone: (863) 231-4252
Fax: (386) 676-2560
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: 2004-07-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
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 |
|---|---|---|---|---|
| O20040730000409 | O | Clinic/Group Practice | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 32174)
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