James L. Andersen, M.D.

Primary specialty

Addiction Medicine (Preventive Medicine) PhysicianTaxonomy code 2083A0300X

License

ME0024931 Issued in FL

Practice address

805 Crystal Beach Road
Eagle Lake, FL 33839

Phone

(863) 287-3485

Fax

(863) 683-9180

NPI assigned

May 1, 2007

Last updated

Nov 14, 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Environmental Concepts and Services

  • Health Maintenance Organization
  • Lakeland, FL
  • NPI 1730433590
  NPD (past)
• Winter Haven Hospital Inc

  • General Acute Care Hospital
  • Winter Haven, FL
  • NPI 1477599975
  NPD (past)

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1104047695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 CRYSTAL BEACH ROAD",
            "city": "EAGLE LAKE",
            "state": "FL",
            "postal_code": "33839",
            "telephone_number": "863-287-3485",
            "fax_number": "863-683-9180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 CRYSTAL BEACH ROAD",
            "city": "EAGLE LAKE",
            "state": "FL",
            "postal_code": "33839",
            "telephone_number": "863-287-3485",
            "fax_number": "863-683-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "JAMES",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "FL",
            "license": "ME0024931",
            "primary": true
        },
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "FL",
            "license": "ME0024931",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Donald Blackburn II
• Family Bridge Support Services LLC
• Maranda Gardner
• Shanell Vontres Gray
• Heart of Resilience Homecare

• Addiction Medicine (Preventive Medicine) Physician in Eagle Lake, FL
• Providers in Eagle Lake, FL by specialty
• Addiction Medicine (Preventive Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.