NPIMap

Organization Active NPI

Sacred Heart Medical GRP at Destin

Doing business as SHMG Emerald Coast Specialists

  • Otolaryngology Physician
  • Pensacola, FL
National Provider Identifier
1205887650
Registry record updated Apr 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
SACRED HEART MEDICAL GRP AT DESTIN
Doing business as
SHMG Emerald Coast Specialists
Practice address
4451 Bayou Blvd
Pensacola, FL 32503-2601
Phone
(850) 475-4500
Fax
(850) 475-4771
NPI assigned
May 12, 2006
Last updated
Apr 11, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2012

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

Authorized official

Name
Mrs. Jan Foley
Title
Enrollment Specialist
Phone
(850) 475-4620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

4451 Bayou Blvd
Pensacola, FL 32503-2601

Mailing address

PO Box 2699
Healthplan Enrollment
Pensacola, FL 32513-2699
Phone (850) 475-4620

Other names 1

  • SHMG Emerald Coast Specialists Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334102400000",
    "number": "1205887650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2699",
            "address_2": "HEALTHPLAN ENROLLMENT",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325132699",
            "telephone_number": "850-475-4620",
            "fax_number": "850-416-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4451 BAYOU BLVD",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032601",
            "telephone_number": "850-475-4500",
            "fax_number": "850-475-4771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED HEART MEDICAL GRP AT DESTIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2012-04-11",
        "status": "A",
        "authorized_official_last_name": "FOLEY",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "850-475-4620",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHMG Emerald Coast Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.