Individual provider Active NPI

Sally Kathleen Hinman, M.D., PH.D.

  • Family Medicine Physician
  • Daytona Beach, FL
National Provider Identifier
1144667544
Registry record updated Nov 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME124818 Issued in FL
Practice address
201 N Clyde Morris Blvd Ste 200
Daytona Beach, FL 32114-2765
Phone
(386) 425-4165
Fax
(386) 425-7545
NPI assigned
May 28, 2013
Last updated
Nov 13, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME124818 FL Primary

Addresses

Primary practice location

201 N Clyde Morris Blvd Ste 200
Daytona Beach, FL 32114-2765

Mailing address

303 N Clyde Morris Blvd
Daytona Beach, FL 32114-2709
Phone (386) 425-0141

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191031002391 FL Practitioner - Family Practice 1355585324 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Dentistry, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Halifax Healthcare Systems IncGroup PAC ID 1254238090, 345 clinicians

Practice addresses (Care Compare)

201 N Clyde Morris Blvd
Suite 300
Daytona Beach, FL 32114-2765
Phone (386) 947-4641

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME124818FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Halifax Healthcare Systems Inc Family Medicine CurrentSince Oct 27, 2019 Accepting new patients

Locations

201 N Clyde Morris Blvd
Ste 200
Daytona Beach, FL 32114
Phone (386) 254-4165

201 N Clyde Morris Blvd
Ste 300
Daytona Beach, FL 32114
Phone (386) 236-7017

303 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 425-2285

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: sally.hinman.1@16462.direct.athenahealth.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1369699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573603200000",
    "number": "1144667544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142709",
            "telephone_number": "386-425-0141",
            "fax_number": "386-226-4590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N CLYDE MORRIS BLVD STE 200",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142765",
            "telephone_number": "386-425-4165",
            "fax_number": "386-425-7545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HINMAN",
        "first_name": "SALLY",
        "middle_name": "KATHLEEN",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-28",
        "last_updated": "2019-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME124818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.