Individual provider Active NPI

Linda Jane Palmer, DPM

  • Podiatrist
  • Brandon, FL
National Provider Identifier
1104833318
Registry record updated Sep 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PO2868 Issued in FL
Practice address
1149 Professional Park Dr
Brandon, FL 33511-4887
Phone
(813) 685-3668
Fax
(813) 685-5430
NPI assigned
Aug 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X PO2868 FL Primary

Addresses

Primary practice location

1149 Professional Park Dr
Brandon, FL 33511-4887

Mailing address

1149 Professional Park Dr
Brandon, FL 33511-4887
Phone (813) 685-3668

Other identifiers 1

IdentifierTypeStateIssuer
010404200MedicaidFL

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040825001267 FL Practitioner - Podiatry 0547234346 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Barry University School of Podiatric Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kristi L Conway DPM PAGroup PAC ID 5799831855, 2 clinicians

Practice addresses (Care Compare)

1149 Professional Park Dr
Brandon, FL 33511-4887
Phone (813) 685-3668

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue78

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PO2868FLMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Kristi L Conway DPM PA Podiatrist CurrentSince Jul 1, 2016 Accepting new patients
Harvard Podiatry PastSince Nov 23, 1998 Accepting new patients
Harvard Podiatry Past Accepting new patients
Gary S Wallach DPM PA PastSince Nov 29, 2004 Accepting new patients

Locations

1149 Professional Park Dr
Brandon, FL 33511
Phone (813) 685-3668

Interoperability endpoints

  • Direct secure messaging: lpalmer@bapc.emadirect.md

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473120000000",
    "number": "1104833318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 PROFESSIONAL PARK DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114887",
            "telephone_number": "813-685-3668",
            "fax_number": "813-685-5430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1149 PROFESSIONAL PARK DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114887",
            "telephone_number": "813-685-3668",
            "fax_number": "813-685-5430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALMER",
        "first_name": "LINDA",
        "middle_name": "JANE",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2016-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "FL",
            "license": "PO2868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010404200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.