Promise Medical Group, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME106525 Issued in FL

Legal business name

PROMISE MEDICAL GROUP, PLLC

Practice address

9202 NW 26TH St
Wildwood, FL 34785-7413

Phone

(352) 812-0579

Fax

(352) 571-4349

NPI assigned

Sep 19, 2012

Last updated

Jul 29, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David Wayne Stephenson, MDNPI 1093983157

Title

President

Phone

(352) 812-0579

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Wayne Stephenson, MD

  • Internal Medicine Physician
  • Wildwood, FL
  • NPI 1093983157
  Medicare reassignment NPD Authorized official
• Asm Mujibur Rahman, MD

  • Internal Medicine Physician
  • Ocala, FL
  • NPI 1871789487
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1043560832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9202 NW 26TH ST",
            "city": "WILDWOOD",
            "state": "FL",
            "postal_code": "347857413",
            "telephone_number": "352-812-0579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9202 NW 26TH ST",
            "city": "WILDWOOD",
            "state": "FL",
            "postal_code": "347857413",
            "telephone_number": "352-812-0579",
            "fax_number": "352-571-4349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMISE MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-19",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "STEPHENSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-812-0579",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME106525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "FD876Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Wildwood, FL
• Providers in Wildwood, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.