Benjamin Reed Nettleton, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS13715 Issued in FL

Practice address

5005 Port St John Pkwy
Suite 2500
Port St John, FL 32927-4305

Phone

(321) 504-0556

Fax

(321) 504-0773

NPI assigned

May 1, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Our Lady of Lourdes Health Center

  dba Lourdes Family Health Center

  • Primary Care Clinic/Center
  • Connell, WA
  • NPI 1538213616
  NPD (past)
• Our Lady of Lourdes Health Center

  dba Lourdes Urology East

  • Urology Physician
  • Pasco, WA
  • NPI 1649785569
  NPD (past)

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

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483488000000",
    "number": "1164698932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 CENTURY MEDICAL DR",
            "address_2": "CREDENTIALING OFFICE",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962100",
            "telephone_number": "321-268-6264",
            "fax_number": "321-268-6273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5005 PORT ST JOHN PKWY",
            "address_2": "SUITE 2500",
            "city": "PORT ST JOHN",
            "state": "FL",
            "postal_code": "329274305",
            "telephone_number": "321-504-0556",
            "fax_number": "321-504-0773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETTLETON",
        "first_name": "BENJAMIN",
        "middle_name": "REED",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-01",
        "last_updated": "2017-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OT011289",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP0077518",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS13715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "249449",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8544645",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019231000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shivani Mitra, MD
• Carmen E. Morales, M.D.
• Matthew Anthony Musto, DO
• Myeyedr Optometry of Florida, LLC (MyEyeDr.)
• William J. Near, M.D.
• Hiram Nieves Sr.
• North Brevard County Hospital District (Parrish Medical Center)
• North Brevard Medical Support, Inc
• North Brevard Medical Support, Inc
• North Brevard Medical Support, Inc

• Family Medicine Physician in Port St John, FL
• Providers in Port St John, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.