Phung Dinh Phan, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS20770 Issued in FL

Practice address

1625 Shepherd Rd
Lakeland, FL 33811-2122

Phone

(863) 284-1626

NPI assigned

Aug 4, 2012

Last updated

May 30, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Lake Erie Col of Osteopathic Medicine, Bradenton, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lakeland Regional Health Systems IncGroup PAC ID 8325952914, 513 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lakeland Regional Medical Center Hospital, Lakeland, FL, CCN 100157

Merit-based Incentive Payment System (MIPS)

Final score

86.12 of 100Reported as group

Quality

64.08

Promoting interoperability

98

Improvement activities

40

Cost

76.83

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lakeland Regional Health Systems, Inc.

  • Multi-Specialty Clinic/Center
  • Lakeland, FL
  • NPI 1497748743
  Medicare reassignment Care Compare group NPD
• Lakeland Regional Health System, Inc.

  • Multi-Specialty Clinic/Center
  • Lakeland, FL
  • NPI 1851146468

  Family Medicine

  NPD (past)
• Lakeland Regional Medical Center, Inc.

  dba Lakeland Regional Medical Center

  • General Acute Care Hospital
  • Lakeland, FL
  • NPI 1144228446
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lakeland Regional Medical Center, Inc.

  dba Lakeland Regional Medical Center

  • General Acute Care Hospital
  • Lakeland, FL
  • NPI 1144228446
  Care Compare affiliation

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

{
    "created_epoch": "1344038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1043567407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "UNIT 28038 BLD 700",
            "city": "APO",
            "state": "AE",
            "postal_code": "09112",
            "telephone_number": "314-590-3904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SHEPHERD RD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338112122",
            "telephone_number": "863-284-1626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Unit 28130, Building 475",
            "address_purpose": "LOCATION",
            "city": "APO",
            "state": "AE",
            "postal_code": "09114",
            "country_code": "US",
            "telephone_number": "314-590-3176",
            "country_name": "United States",
            "address_type": "MIL"
        },
        {
            "address_1": "3030 Harden Blvd",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338037952",
            "country_code": "US",
            "telephone_number": "863-284-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4710 S Florida Ave",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338132165",
            "country_code": "US",
            "telephone_number": "863-284-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAN",
        "first_name": "PHUNG",
        "middle_name": "DINH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-04",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "NE",
            "license": "1141",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "1141",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS20770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Baylin Pfluke, ARNP
• Khanh Thu Pham, MD
• Thach Pham, D.M.D
• Thuy Linh Pham, APRN
• Tri Minh Pham, MD
• Philadelphia Professionals Inc
• Rengit Philip, MD
• Rosemie Philippe, LMHC
• Phillips Salomon & Parrish PA
• Phillips Salomon & Parrish PA

• Family Medicine Physician in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.