Individual provider Active NPI

Lawrence D Kaelin, M.D.

  • Vascular Surgery Physician
  • Tallahassee, FL
National Provider Identifier
1073540282
Registry record updated Mar 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
ME0049211 Issued in FL
Practice address
2631 Centennial Blvd
Suite 100
Tallahassee, FL 32308-0588
Phone
(850) 877-8539
Fax
(850) 877-6674
NPI assigned
Jun 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X ME0049211 FL Primary

Addresses

Primary practice location

2631 Centennial Blvd
Suite 100
Tallahassee, FL 32308-0588

Mailing address

2631 Centennial Blvd
Suite 100
Tallahassee, FL 32308-0588
Phone (850) 877-8539

Other identifiers 2

IdentifierTypeStateIssuer
00517976AMedicaidGA
370231600MedicaidFL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100503000743 FL Practitioner - Vascular Surgery 6608820386 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Louisville School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cardiothoracic and Vascular Surgical Associates PAGroup PAC ID 5395725188, 85 clinicians

Practice addresses (Care Compare)

1824 King St
Suite 200
Jacksonville, FL 32204-4736
Phone (904) 384-3343

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Leg revascularization (restoring blood flow)14
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0049211FLMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cardiothoracic & Vascular Surgical Associates PA Vascular Surgery CurrentSince Sep 1, 2020 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

1824 King St
Ste 200
Jacksonville, FL 32204
Phone (904) 384-3343

801 E 6th St
Ste 205
Panama City, FL 32401
Phone (850) 785-3185

4451 Bayou Blvd
Pensacola, FL 32503
Phone (850) 416-7619

2631 Centennial Blvd
Tallahassee, FL 32308
Phone (850) 702-0579

2631 Centennial Blvd
Ste 100
Tallahassee, FL 32308
Phone (850) 877-8539

2623 Centennial Blvd
Ste 101
Tallahassee, FL 32308
Phone (850) 270-7374

Networks

  • Freedom Health HMO Network

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 1

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": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490918400000",
    "number": "1073540282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2631 CENTENNIAL BLVD",
            "address_2": "SUITE 100",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323080588",
            "telephone_number": "850-877-8539",
            "fax_number": "850-877-6674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2631 CENTENNIAL BLVD",
            "address_2": "SUITE 100",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323080588",
            "telephone_number": "850-877-8539",
            "fax_number": "850-877-6674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAELIN",
        "first_name": "LAWRENCE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2017-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "FL",
            "license": "ME0049211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00517976A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370231600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.