Active NPI
Carol M Gaines, DO
- Family Medicine Physician
- Port Orange, FL
National Provider Identifier
1235117102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS10126
- Practice address
- 5535 S. Williamson Blvd
Suite 700
Port Orange, FL 32128-8311 - Phone
- (386) 231-6300
- Fax
- (386) 322-6165
- NPI assigned
- Jan 2, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS10126 | FL | Primary |
Addresses
Primary practice location
5535 S. Williamson Blvd
Suite 700
Port Orange, FL 32128-8311
Mailing address
5535 S Williamson Blvd
Suite 700
Port Orange, FL 32128-8311
Phone (740) 707-1647
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08CBCLW | Other | GA | MEDICARE |
| 489023752B | Medicaid | GA |
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)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5590 | OH | MD | Optometrist |
| OS10126 | FL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Medical Associates Inc | Past | Accepting new patients | |
| Candler Medical Group, Inc. - Downtown | Family Medicine | Past | Accepting new patients |
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.
-
- Family Medicine Physician
- Savannah, GA
- NPI 1396761953
-
- Registered Nurse
- Athens, OH
- NPI 1376889675
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483488000000",
"number": "1235117102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5535 S WILLIAMSON BLVD",
"address_2": "SUITE 700",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321288311",
"telephone_number": "740-707-1647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5535 S. WILLIAMSON BLVD",
"address_2": "SUITE 700",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321288311",
"telephone_number": "386-231-6300",
"fax_number": "386-322-6165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAINES",
"first_name": "CAROL",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-02",
"last_updated": "2017-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "OS10126",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "08CBCLW",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "489023752B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Orange, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.