Active NPI
Michael Dallas Watson, MS
- Contractor
- Juno Beach, FL
National Provider Identifier
1124421359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 999999999
- Practice address
- 12575 US Highway 1
Ste 200
Juno Beach, FL 33408-2477 - Phone
- (561) 284-7899
- NPI assigned
- Oct 2, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 999999999 | NY | Primary |
Addresses
Primary practice location
12575 US Highway 1
Ste 200
Juno Beach, FL 33408-2477
Mailing address
4952 W Liberty Park Cir
North Charleston, SC 29405-4009
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 999999999 | Other | SC | TEST |
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 999999999 | NY | MD | Health Educator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412208000000",
"number": "1124421359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4952 W LIBERTY PARK CIR",
"city": "NORTH CHARLESTON",
"state": "SC",
"postal_code": "294054009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12575 US HIGHWAY 1",
"address_2": "STE 200",
"city": "JUNO BEACH",
"state": "FL",
"postal_code": "334082477",
"telephone_number": "561-284-7899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "MICHAEL",
"middle_name": "DALLAS",
"credential": "MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-02",
"last_updated": "2014-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "NY",
"license": "999999999",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEST",
"identifier": "999999999",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Juno Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.