Joseph Vickaryous D.O. P.a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS9338 Issued in FL

Legal business name

JOSEPH VICKARYOUS D.O. P.A.

Doing business as

MARCO ISLAND MEDICAL CENTER

Practice address

531 Bald Eagle Dr
Marco Island, FL 34145-2700

Phone

(239) 393-2000

Fax

(239) 393-0355

NPI assigned

Dec 16, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Joseph Vickaryous, D.O.NPI 1750475240

Title

Owner

Phone

(239) 393-2000

Specialties & licenses 1

Addresses

Other names 1

• MARCO ISLAND MEDICAL CENTER Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph P Vickaryous, D.O.

  • General Practice Physician
  • Marco Island, FL
  • NPI 1750475240

  Family Medicine

  Medicare reassignment NPD Authorized official
• Amanda Brink, FNP-BC

  • Family Nurse Practitioner
  • Houston, TX
  • NPI 1568871101

  FL

  Medicare reassignment NPD
• Christopher Martin Hatwell, PA-C

  • Physician Assistant
  • Marco Island, FL
  • NPI 1164773610
  Medicare reassignment

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

{
    "created_epoch": "1260921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377561600000",
    "number": "1164751400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 BALD EAGLE DR",
            "city": "MARCO ISLAND",
            "state": "FL",
            "postal_code": "341452700",
            "telephone_number": "239-393-2000",
            "fax_number": "239-393-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 BALD EAGLE DR",
            "city": "MARCO ISLAND",
            "state": "FL",
            "postal_code": "341452700",
            "telephone_number": "239-393-2000",
            "fax_number": "239-393-0355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH VICKARYOUS D.O. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-16",
        "last_updated": "2013-08-27",
        "status": "A",
        "authorized_official_last_name": "VICKARYOUS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-393-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS9338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARCO ISLAND MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jinel Jevana Jones
• Mia Jones
• Monique Dorriece Jones
• Nyron Jones
• Joseph F Lang MD PL
• Josephine V Jasper MD PA
• Walter Bruce Kane II, DO
• Pia Elaine Kennedy
• Alysia Suvin Kim
• Randi Lea Kirkpatrick

• Family Medicine Physician in Marco Island, FL
• Providers in Marco Island, 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 Aug 27, 2013; 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.