NPIMap

Individual provider Active NPI

Stephen G Pelham, MD

  • Family Medicine Physician
  • Holmes Beach, FL
National Provider Identifier
1073508206
Registry record updated Mar 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME36812 Issued in FL
Practice address
3909 E Bay Dr
Suite 100
Holmes Beach, FL 34217-1997
Phone
(941) 778-1007
Fax
(941) 778-9256
NPI assigned
Sep 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME36812 FL Primary

Addresses

Primary practice location

3909 E Bay Dr
Suite 100
Holmes Beach, FL 34217-1997

Mailing address

3909 E Bay Dr
Suite 100
Holmes Beach, FL 34217-1997
Phone (941) 778-1007

Other identifiers 3

IdentifierTypeStateIssuer
065258000MedicaidFL
51125OtherFLBCBS
80124988OtherFLRAIL ROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100130000356 FL Practitioner - Family Practice 0143363127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Westside Medical Care, IncGroup PAC ID 9335108851, 6 clinicians

Practice addresses (Care Compare)

2225 59TH St W
Suite B
Bradenton, FL 34209-7006
Phone (941) 792-1412

Hospital & facility affiliations

  • HCA Florida Healthcare at Home Home health agency, Bradenton, FL, CCN 107656
  • Haven Home Health Care Home health agency, Riverview, FL, CCN 687113
  • Etairos Health Inc Home health agency, Tampa, FL, CCN 109428
  • Florida Home Health Home health agency, Bradenton, FL, CCN 108049
  • HCA Florida Blake Hospital Hospital, Bradenton, FL, CCN 100213
  • Sarasota Memorial Hospital Hospital, Sarasota, FL, CCN 100087

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME36812FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Physician Network, LLC Family Medicine Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ABIACD/Endpoint/ABIACD

Organizations & group practices 2

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

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396224000000",
    "number": "1073508206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3909 E BAY DR",
            "address_2": "SUITE 100",
            "city": "HOLMES BEACH",
            "state": "FL",
            "postal_code": "342171997",
            "telephone_number": "941-778-1007",
            "fax_number": "941-778-9256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3909 E BAY DR",
            "address_2": "SUITE 100",
            "city": "HOLMES BEACH",
            "state": "FL",
            "postal_code": "342171997",
            "telephone_number": "941-778-1007",
            "fax_number": "941-778-9256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELHAM",
        "first_name": "STEPHEN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2014-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME36812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "065258000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "51125",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "80124988",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holmes Beach, FL

Sources for this page

Verify at the official NPI Registry.