Lyle E Wadsworth MD PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME30902 Issued in FL

Legal business name

LYLE E WADSWORTH MD PA

Practice address

890 N Boundary Ave Ste 102
Deland, FL 32720-3173

Phone

(386) 740-0224

NPI assigned

Nov 30, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Lyle E. Wadsworth, MDNPI 1356347561

Title

President

Phone

(386) 740-0224

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lyle E Wadsworth, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Deland, FL
  • NPI 1356347561
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204761600000",
    "number": "1205018207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "890 N BOUNDARY AVE STE 102",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327203173",
            "telephone_number": "386-740-0224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 N BOUNDARY AVE STE 102",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327203173",
            "telephone_number": "386-740-0224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYLE E WADSWORTH MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-30",
        "last_updated": "2008-03-06",
        "status": "A",
        "authorized_official_last_name": "WADSWORTH",
        "authorized_official_first_name": "LYLE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-740-0224",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME30902",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME30902",
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "FL",
            "license": "ME30902",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "64391",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE",
            "identifier": "000050266105",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5490138",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2198298007",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawna Lucas
• Rita A Lunardi, LMT
• Melissa I Lundell, LMHC
• Sara Alynn Lunsford, PHARMD
• Kasey Maureen Lustik
• Anika Lynch
• Susan Patricia Lynch, APRN
• M. Wharry, Inc.
• Morgan Macintyre, DO
• Judy R Macnichols, P.A.-C

• Internal Medicine Physician in Deland, FL
• Providers in Deland, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.