Individual provider Active NPI

David T. Stewart Jr., M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Tallahassee, FL
National Provider Identifier
1225008667
Registry record updated Sep 14, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
ME62064 Issued in FL
Practice address
1899 Eider CT
Tallahassee, FL 32308-4537
Phone
(850) 878-5143
Fax
(850) 942-6622
NPI assigned
Jan 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X ME62064 FL Primary

Addresses

Primary practice location

1899 Eider CT
Tallahassee, FL 32308-4537

Mailing address

1899 Eider CT
Tallahassee, FL 32308-4537
Phone (850) 878-5143

Other identifiers 3

IdentifierTypeStateIssuer
18076OtherFLBCBS INDIVIDUAL PROVIDER#
ME62064OtherFLFL MEDICAL EXAMINER LICEN
3720578MedicaidFL

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
I20100327000297 FL Practitioner - Pathology 7911092630 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of New Mexico School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1899 Eider CT
Tallahassee, FL 32308-4537
Phone (850) 878-5143

Hospital & facility affiliations

  • Jackson Hospital Hospital, Marianna, FL, CCN 100142

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ketchum Wood & Burgert Chartered DRS Ketchum Wood & Burgert CurrentSince Apr 6, 1992 Accepting new patients
Ketchum Wood & Burgert Chartered DRS Ketchum Wood & Burgert Anatomic Pathology & Clinical Pathology CurrentSince Apr 6, 1992 Accepting new patients

Locations

1899 Eider Ct
Tallahassee, FL 32308
Phone (850) 878-5143

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 and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189728000000",
    "number": "1225008667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1899 EIDER CT",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084537",
            "telephone_number": "850-878-5143",
            "fax_number": "850-942-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1899 EIDER CT",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084537",
            "telephone_number": "850-878-5143",
            "fax_number": "850-942-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "DAVID",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2007-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "ME62064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INDIVIDUAL PROVIDER#",
            "identifier": "18076",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL MEDICAL EXAMINER LICEN",
            "identifier": "ME62064",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3720578",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.