Active NPI
Austin George Dupont, MD
- Pediatrics Physician
- Macclenny, FL
National Provider Identifier
1194385690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME157220
- Practice address
- 159 N 3Rd St
Macclenny, FL 32063-2103 - Phone
- (904) 259-7815
- Fax
- (904) 774-0001
- NPI assigned
- Jun 17, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME157220 | FL | Primary |
Addresses
Primary practice location
159 N 3Rd St
Macclenny, FL 32063-2103
Mailing address
159 N 3Rd St
Macclenny, FL 32063-2103
Phone (419) 259-7815
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 115189000 | 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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME157220 | FL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Privia Medical Group Florida, LLC | Past | Accepting new patients |
Interoperability endpoints
- austin.dupont.2@8042.direct.athenahealth.com
Organizations & group practices 1
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.
-
- General Practice Physician
- Indialantic, FL
- NPI 1700649043
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725926400000",
"number": "1194385690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "159 N 3RD ST",
"city": "MACCLENNY",
"state": "FL",
"postal_code": "320632103",
"telephone_number": "419-259-7815",
"fax_number": "904-774-0001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "159 N 3RD ST",
"city": "MACCLENNY",
"state": "FL",
"postal_code": "320632103",
"telephone_number": "904-259-7815",
"fax_number": "904-774-0001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUPONT",
"first_name": "AUSTIN",
"middle_name": "GEORGE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-17",
"last_updated": "2024-09-10",
"certification_date": "2024-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME157220",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "115189000",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Macclenny, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.