Active NPI
Stephen G Vernon, DO
- General Practice Physician
- Sumterville, FL
National Provider Identifier
1174502801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- OS12788
- Practice address
- 1425 S US 301
Sumterville, FL 33585-5141 - Phone
- (352) 793-5900
- Fax
- (352) 793-6269
- NPI assigned
- Jan 11, 2006
- Last updated
- Mar 15, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS12788 | FL | |
| General Practice Physician | 208D00000X | OS12788 | FL | Primary |
Addresses
Primary practice location
1425 S US 301
Sumterville, FL 33585-5141
Mailing address
1425 S US 301
Sumterville, FL 33585-5141
Phone (352) 793-5900
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 795005500 | Medicaid | MD | |
| 014061400 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients | |
| Eastern Shore Emergency Medicine Physicians, LLC | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Emergency Medicine Physician
- Cambridge, MD
- NPI 1558314203
-
dba Frederick Health Hospital
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458000000000",
"number": "1174502801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1425 S US 301",
"city": "SUMTERVILLE",
"state": "FL",
"postal_code": "335855141",
"telephone_number": "352-793-5900",
"fax_number": "352-793-6269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1425 S US 301",
"city": "SUMTERVILLE",
"state": "FL",
"postal_code": "335855141",
"telephone_number": "352-793-5900",
"fax_number": "352-793-6269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VERNON",
"first_name": "STEPHEN",
"middle_name": "G",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-11",
"last_updated": "2016-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "OS12788",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "FL",
"license": "OS12788",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "795005500",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "014061400",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sumterville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.