Marjorie Dina Bacon, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME158234 Issued in FL

Practice address

442 Paseo Reyes Dr
St Augustine, FL 32095-8558

Phone

(904) 544-1738

Fax

(904) 872-8863

NPI assigned

May 11, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 9, 2023 through Jul 9, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1174145304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "442 PASEO REYES DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320958558",
            "telephone_number": "904-544-1738",
            "fax_number": "904-872-8863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "442 PASEO REYES DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320958558",
            "telephone_number": "904-544-1738",
            "fax_number": "904-872-8863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "MARJORIE",
        "middle_name": "DINA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-11",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "338808",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "1908R77909",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME158234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jezebel Ayala
• Sandi Aymond
• Shadi Ayyoub
• Sarah A. Babcock, CM
• Back in Motion P.a.
• Logein Badi
• Badri N Mehrotra MD PA
• Randy Bagay, DDS
• Bailey Spine & Wellness, LLC
• Erin Nicole Bailey, D.C.

• Family Medicine Physician in St Augustine, FL
• Providers in St Augustine, 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 Jul 16, 2025; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.