Individual provider Active NPI

Jack E Baron, MD

  • Family Medicine Physician
  • Englewood, FL
National Provider Identifier
1174543441
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME38100 Issued in FL
Practice address
3000 S McCall Rd
Englewood, FL 34224-8616
Phone
(941) 406-9029
Fax
(941) 406-9028
NPI assigned
Jul 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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 ME38100 FL Primary

Addresses

Primary practice location

3000 S McCall Rd
Englewood, FL 34224-8616

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
08105OtherFLBCBS

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20041018000995 FL Practitioner - Family Practice 2163482753 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC Family Medicine CurrentSince Jun 20, 2016 Accepting new patients
Millennium Physician Group LLC Family Medicine CurrentSince Jun 20, 2016 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

2400 S McCall Rd
Ste C
Englewood, FL 34224
Phone (941) 473-2913

3000 S McCall Rd
Englewood, FL 34224
Phone (941) 406-9029

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

3434 Hancock Bridge Pkwy
Ste 301
North Ft Myers, FL 33903
Phone 877856377411108

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

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1174543441",
    "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": "941-841-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 S MCCALL RD",
            "city": "ENGLEWOOD",
            "state": "FL",
            "postal_code": "342248616",
            "telephone_number": "941-406-9029",
            "fax_number": "941-406-9028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARON",
        "first_name": "JACK",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME38100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "08105",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, FL

Sources for this page

Verify at the official NPI Registry.