NPIMap

Organization Active NPI

Okaloosa Cardiology P a

  • Cardiovascular Disease Physician
  • Crestview, FL
National Provider Identifier
1144270240
Registry record updated Aug 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
OKALOOSA CARDIOLOGY P A
Practice address
129 E Redstone Ave
Suite a
Crestview, FL 32539-5350
Phone
(850) 682-7212
NPI assigned
May 11, 2006
Last updated
Aug 25, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2011

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

Authorized official

Name
Donna M Gibson
Title
Billing Manager
Phone
(850) 682-7212

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary
Vascular Surgery Physician 2086S0129X NU

Addresses

Primary practice location

129 E Redstone Ave
Suite a
Crestview, FL 32539-5350

Mailing address

129 E Redstone Ave
Suite a
Crestview, FL 32539-5350
Phone (850) 682-7212

Other identifiers 1

IdentifierTypeStateIssuer
258928100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040608000466 FL Part B Supplier - Clinic/Group Practice 7315920899 Receives reassigned benefits from 23 practitioners
Practice locations: Crestview, FL; Niceville, FL; Ft Walton BCH, FL; Destin, FL; Fort Walton Beach, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0976637Okaloosa Cardiology PA129 E Redstone Aveune Suite a, Crestview, FL 32539Certificate of waiverAug 9, 2026

National Provider Directory

National Provider Directory

Locations

129 E Redstone Ave
Ste A
Crestview, FL 32539
Phone (850) 682-7212

4415 US Highway 331 S
Ste E
Defuniak Springs, FL 32435
Phone (850) 682-7212

36468 Emerald Coast Pkwy
Ste 101
Destin, FL 32541

36468 Emerald Coast Pkwy
Ste 110
Destin, FL 32541

996 Airport Rd
Ste 100
Destin, FL 32541
Phone (850) 682-7212

1032 Mar Walt Dr
Unit 110
Ft Walton Bch, FL 32547
Phone (850) 862-1753

921 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 388-4333

1905 Andorra St
Ste 100
Navarre, FL 32566
Phone (850) 682-7212

1001 College Blvd W
Ste B
Niceville, FL 32578
Phone (850) 678-0144

2600 Partin Dr N
Ste 110
Niceville, FL 32578
Phone (850) 517-6578

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/0009543

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314230400000",
    "number": "1144270240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 E REDSTONE AVE",
            "address_2": "SUITE A",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325395350",
            "telephone_number": "850-682-7212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 E REDSTONE AVE",
            "address_2": "SUITE A",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325395350",
            "telephone_number": "850-682-7212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKALOOSA CARDIOLOGY P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2011-08-25",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "850-682-7212"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "258928100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.