NPIMap

Individual provider Active NPI

Bryan James Smith, MD

  • Internal Medicine Physician
  • Fort Walton Beach, FL
National Provider Identifier
1104868033
Registry record updated Feb 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME107850 Issued in FL
Practice address
1005 Mar Walt Drive
Fort Walton Beach, FL 32547-6796
Phone
(850) 863-8100
Fax
(850) 862-2303
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME107850 FL Primary

Addresses

Primary practice location

1005 Mar Walt Drive
Fort Walton Beach, FL 32547-6796

Mailing address

1005 Mar Walt Drive
Fort Walton Beach, FL 32547-6796
Phone (850) 863-8100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
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
I20190131001554 VT Practitioner - Hospitalist 9032105077 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Sanford School of Medicine of University of South Dakota, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gifford Medical Center IncGroup PAC ID 4880683663, shared by 3 NPIs, 55 clinicians

Practice addresses (Care Compare)

44 S Main St
Randolph, VT 05060-1381
Phone (802) 728-7000

Hospital & facility affiliations

  • Gifford Medical Center Hospital, Randolph, VT, CCN 471301
  • Mary Hitchcock Memorial Hospital Hospital, Lebanon, NH, CCN 300003
  • Gifford Medical Center Nursing home, CCN 47Z301

Merit-based Incentive Payment System (MIPS)

Final score
80.28 of 100Reported as group
Quality
58.32
Promoting interoperability
100
Improvement activities
40
Cost
66.48

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Gifford Medical Center Inc. CurrentSince Jan 22, 2019 Accepting new patients
Gifford Medical Center Inc CurrentSince Feb 8, 2026 Accepting new patients
Gifford Medical Center Inc CurrentSince Jan 22, 2019 Accepting new patients
Gulf Coast Hma Physician Management LLC Internal Medicine Past Accepting new patients
Gulf Coast Hma Physician Management LLC Past Accepting new patients
Im Healthcare PA Internal Medicine Past Accepting new patients
Sacred Heart Health System, Inc. Past Accepting new patients
Associates in Medicine & Surgery LLC Internal Medicine PastSince May 12, 2014 Accepting new patients

Locations

44 S Main St
Randolph, VT 05060
Phone (802) 728-4441

Organizations & group practices 8

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 4

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": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392076800000",
    "number": "1104868033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 MAR WALT DRIVE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476796",
            "telephone_number": "850-863-8100",
            "fax_number": "850-862-2303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 MAR WALT DRIVE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476796",
            "telephone_number": "850-863-8100",
            "fax_number": "850-862-2303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "BRYAN",
        "middle_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2014-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME107850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

Verify at the official NPI Registry.