TRAUMA & SPECIALTY SURGERY INSTITUTE, LLC (NPI# 1275667057) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275667057 |
| Entity Type | Organization |
| Organization Name | TRAUMA & SPECIALTY SURGERY INSTITUTE, LLC |
| Practice Address |
311 N Clyde Morris Blvd Suite 300 Daytona Beach FL 32114-2781 |
| Mailing Address |
126 Se Mira Lavella Port Saint Lucie FL 34984-6615 |
| Practice Telephone | 3862520688 |
| Practice Fax Number | 3866756401 |
| Mailing Telephone | 7723454445 |
| Mailing Fax Number | 7723454442 |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2017-04-27 |
| Authorized Official Name | MRS. LORI JAZAREVIC (OFFICE MANAGER) |
| Authorized Official Telephone | 7722336166 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
ME65570 | FL | Allopathic & Osteopathic Physicians |
| N | 2086S0102X |
Surgery Specialization: Surgical Critical Care |
ME65570 | FL | Allopathic & Osteopathic Physicians |
| N | 2086S0127X |
Surgery Specialization: Trauma Surgery |
ME65570 | FL | Allopathic & Osteopathic Physicians |
| Y | 208600000X | Surgery | ME 65570 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | MEDICAL LICENSE | ME 65570 | 01 |
| Street Address |
311 N CLYDE MORRIS BLVD SUITE 300 |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32114-2781 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215933056 | Gary A Wilson | Surgery | 311 N Clyde Morris Blvd, Daytona Beach, FL 32114-2781 | 2005-06-27 |
| 1699144436 | Diane Santopadre | Nurse Practitioner | 311 N Clyde Morris Blvd, Suite 420, Daytona Beach, FL 32114-2781 | 2015-09-23 |
| 1104207281 | Patricia Gonzalez | Nurse Anesthetist, Certified Registered | 311 N Clyde Morris Blvd, Daytona Beach, FL 32114-2781 | 2015-06-14 |
| 1881001162 | Kimberly W Stackpole | Physician Assistant | 311 N Clyde Morris Blvd, Suite 320, Daytona Beach, FL 32114-2781 | 2014-07-17 |
| 1871918110 | Jennifer Battani | Nurse Anesthetist, Certified Registered | 311 N Clyde Morris Blvd, Daytona Beach, FL 32114-2781 | 2014-02-24 |
| 1609111855 | Digon Diabetes and Endocrinology, P.a. | Internal Medicine | 311 N Clyde Morris Blvd, Suite 440, Daytona Beach, FL 32114-2781 | 2012-11-29 |
| 1063719672 | Kimberly Kay Koevenig | Dietitian, Registered | 311 N Clyde Morris Blvd, Suite 440-outpatient Diabetes Education, Halifax Health, Daytona Beach, FL 32114-2781 | 2011-02-16 |
| 1376871467 | January Y Eudy | Nurse Anesthetist, Certified Registered | 311 N Clyde Morris Blvd, Ste 350, Daytona Beach, FL 32114-2781 | 2009-12-01 |
| 1538325238 | Medical Arts Optical Service,inc | Eyewear Supplier (Equipment, not the service) | 311 N Clyde Morris Blvd, Suite 40, Daytona Beach, FL 32114-2781 | 2008-08-01 |
| 1508036419 | Eric Stephen Piazza | Physician Assistant | 311 N Clyde Morris Blvd, Suite 580, Daytona Beach, FL 32114-2781 | 2008-03-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376161380 | Evolution Health & Performance LLC | Physician Assistant | 244 S. Palmetto Ave, Daytona Beach, FL 32114 | 2020-07-07 |
| 1407480189 | Kierra Imani Kinsey | Behavior Technician | 1128-a Beville Rd, Daytona Beach, FL 32114 | 2020-03-02 |
| 1043776057 | Outreach Community Care Network Inc | Pharmacy | 240 N. Frederick Avenue, Daytona Beach, FL 32114 | 2019-02-14 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1285116491 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1348 W International Speedway Blvd Ste 2, Daytona Beach, FL 32114 | 2018-09-04 |
| 1770085656 | Merina Lee | Occupational Therapist | 1159 Australia Ave., Daytona Beach, FL 32114 | 2018-03-06 |
| 1346752755 | Hand & Upper Extremity Surgery of Daytona Beach, LLC | Non-Pharmacy Dispensing Site | 1241 Ridgewood Ave, Daytona Beach, FL 32114 | 2017-10-26 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| Find all providers in zip 32114 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548674724 | Andrew Fritze | Surgery | 201 N Clyde Morris Blvd Ste 100, Daytona Beach, FL 32114-2765 | 2014-06-16 |
| 1659534063 | Gregory Brent Burgoyne | Surgery | 305 Memorial Medical Pkwy Ste 209, Daytona Beach, FL 32117-5169 | 2008-07-07 |
| 1679766943 | Kyle A Herron | Surgery | 1890 Lpga Blvd Ste 255, Daytona Beach, FL 32117-7207 | 2007-08-21 |
| 1306870704 | Rodrigo Bleza Mateo | Surgery | 311 North Clyde Morris Blvd., Suite 480, Halifax Center for Transplant Services, Daytona Beach, FL 32114-2766 | 2006-07-10 |
| 1457395543 | Stephen H Levine | Surgery | 311 N Clyde Morris Blvd Ste 70, Daytona Beach, FL 32114-2756 | 2006-06-16 |
| 1982641494 | Slobodan Jazarevic | Surgery | 311 N Clyde Morris Blvd Ste 300, Daytona Beach, FL 32114 | 2006-06-01 |
| 1639122880 | Bruce John Ramshaw | Surgery | 201 N Clyde Morris Blvd., Suite 205, Daytona Beach, FL 32114-2765 | 2006-05-18 |
| 1982691077 | Harry H Black | Surgery | 201 North Clyde Morris Blvd, Suite 100, Daytona Beach, FL 32114-2724 | 2005-10-04 |
| 1639166739 | Joel L Sebastien | Surgery | 201 North Clyde Morris Blvd., Suite 100, Daytona Beach, FL 32114-2724 | 2005-10-04 |
| 1306838545 | Christopher Allen Grove | Surgery | 305 Memorial Medical Pkwy, Suite 201, Daytona Beach, FL 32117-5168 | 2005-08-15 |
| Find all providers in DAYTONA BEACH | ||||
| City | DAYTONA BEACH |
| Zip Code | 32114 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.