NPIMap

Individual provider Active NPI

Edward Dominick Tribuzio, M.D.

  • Family Medicine Physician
  • Fernandina Beach, FL
National Provider Identifier
1174501571
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME42515 Issued in FL
Practice address
1132 S 14TH St
Fernandina Beach, FL 32034-2920
Phone
(904) 432-3061
Fax
(904) 432-3062
NPI assigned
Jan 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

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 ME42515 FL Primary

Addresses

Primary practice location

1132 S 14TH St
Fernandina Beach, FL 32034-2920

Mailing address

2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774

Other identifiers 3

IdentifierTypeStateIssuer
NG830OtherFLMEDICARE
067854600MedicaidFL
45033OtherFLBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111227000559 FL Practitioner - Family PracticePractitioner - Geriatric Medicine 2163698093 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians

Practice addresses (Care Compare)

1132 S 14TH St
Fernandina Beach, FL 32034-2920
Phone (904) 277-4690

Hospital & facility affiliations

  • Concierge Home Care Home health agency, Jacksonville, FL, CCN 109742
  • Concierge Home Care Home health agency, Jacksonville, FL, CCN 687131
  • Brooks Rehabilitation Home Health Home health agency, Jacksonville, FL, CCN 103174
  • Pinnacle Home Care Home health agency, Ormond Beach, FL, CCN 108499
  • Welcome Homecare Home health agency, Jacksonville, FL, CCN 107436
  • Community Hospice of Northeast Florida Inc Hospice, Jacksonville, FL, CCN 101500
  • Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545
  • Baptist Medical Center - Nassau Hospital, Fernandina Beach, FL, CCN 100140
  • Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001
  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • Fernandina Beach Rehabilitation and Nursing Center Nursing home, Fernandina Beach, FL, CCN 105470

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME42515FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC Family Medicine CurrentSince Mar 15, 2021 Accepting new patients
Millennium Physician Group LLC Family Medicine CurrentSince Mar 15, 2021 Accepting new patients

Locations

14540 Cortez Blvd
Ste 102
Brooksville, FL 34613
Phone (352) 596-7255

1340 S 18th St
Ste 204
Fernandina Beach, FL 32034
Phone (904) 261-0643

1132 S 14th St
Fernandina Beach, FL 32034
Phone (904) 277-4690

2675 Winkler Ave
Fl 2
Fort Myers, FL 33901
Phone (855) 979-5700

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

Interoperability endpoints

  • Direct secure messaging: edward.tribuzio.1@4290.direct.athenahealth.com

Organizations & group practices 2

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

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1174501571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774",
            "fax_number": "239-599-2612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1132 S 14TH ST",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320342920",
            "telephone_number": "904-432-3061",
            "fax_number": "904-432-3062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIBUZIO",
        "first_name": "EDWARD",
        "middle_name": "DOMINICK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME42515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "NG830",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "067854600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "45033",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fernandina Beach, FL

Sources for this page

Verify at the official NPI Registry.