EMERALD WATERS MEDICAL CLINIC LLC
NPI 1306192216
Nurse Practitioner in Niceville, FL
About Emerald Waters Medical Clinic Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
EMERALD WATERS MEDICAL CLINIC LLC (NPI 1306192216) is a healthcare organization registered as a nurse practitioner in Niceville, Florida and active in the NPI registry since July 2012. The organization lists Mauricia Stanton, Owner/provider, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 4
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Emerald Waters Medical Clinic Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Emerald Waters Medical Clinic LLC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 10D2048190
Emerald Waters Medical Clinic LLC · Niceville, FLFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Emerald Waters Medical Clinic LLC's NPI number?
The NPI number for Emerald Waters Medical Clinic LLC is 1306192216. It was assigned to this organization in the NPPES registry on July 28, 2012.
Where is Emerald Waters Medical Clinic LLC located?
Emerald Waters Medical Clinic LLC is located at 1005 College Blvd W Suite B, Niceville, FL 32578. The listed phone number is (850) 279-6815.
What is Emerald Waters Medical Clinic LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.
Is Emerald Waters Medical Clinic LLC enrolled in Medicare?
Yes. Emerald Waters Medical Clinic LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Emerald Waters Medical Clinic LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Emerald Waters Medical Clinic LLC, in Internal Medicine and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Emerald Waters Medical Clinic LLC was last updated on August 3, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Emerald Waters Medical Clinic Llc · NPI 1306192216
Nurse Practitioner organization in Niceville, Florida. Organization record, active in the CMS NPPES registry since July 28, 2012.
## Identity
- **NPI:** 1306192216 (Entity type: Organization)
- **Enumerated:** July 28, 2012
- **Primary specialty:** Nurse Practitioner · taxonomy 363L00000X
- **Organization subpart:** No
- **Authorized official:** Mauricia Stanton, OWNER/PROVIDER
## Practice location
- **Address:** 1005 COLLEGE BLVD W, SUITE B, Niceville, FL 32578-1060
- **Phone:** (850) 279-6815 · **Fax:** (850) 279-6817
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Internal Medicine (1), Nurse Practitioner (1); 1 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 3, 2022
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1306192216) · Data from the CMS NPPES public registry.