Active NPI
Gregory F Macisaac, MD
- Family Medicine Physician
- Palm Coast, FL
National Provider Identifier
1104895473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0101057756
- Practice address
- 120 Cypress Edge Dr
Suite 210
Palm Coast, FL 32164-8453 - Phone
- (386) 445-4750
- Fax
- (386) 445-4751
- NPI assigned
- Mar 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0101057756 | VA | Primary |
Addresses
Primary practice location
120 Cypress Edge Dr
Suite 210
Palm Coast, FL 32164-8453
Mailing address
120 Cypress Edge Dr
Suite 210
Palm Coast, FL 32164-8453
Phone (386) 445-4750
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ME119474 | Other | FL | FL MEDICAL LICENSE |
| 005620589 | Medicaid | VA | |
| 218728 | Other | VA | ANTHEM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adventhealth Primary Care Network Inc | Family Medicine | Past | Accepting new patients |
| Valley Regional Enterprises, Inc | Past | Accepting new patients |
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.
-
- Family Medicine Physician
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- NPI 1093493637
-
- Urgent Care Clinic/Center
- Strasburg, VA
- NPI 1063666196
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423699200000",
"number": "1104895473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 CYPRESS EDGE DR",
"address_2": "SUITE 210",
"city": "PALM COAST",
"state": "FL",
"postal_code": "321648453",
"telephone_number": "386-445-4750",
"fax_number": "386-445-4751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 CYPRESS EDGE DR",
"address_2": "SUITE 210",
"city": "PALM COAST",
"state": "FL",
"postal_code": "321648453",
"telephone_number": "386-445-4750",
"fax_number": "386-445-4751"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACISAAC",
"first_name": "GREGORY",
"middle_name": "F",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-17",
"last_updated": "2015-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VA",
"license": "0101057756",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FL MEDICAL LICENSE",
"identifier": "ME119474",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "005620589",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "218728",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Palm Coast, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.