Phillip Ashley Pybass, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME111399 Issued in FL

Practice address

1005 Mar Walt Drive
Internal Medicine Department
Fort Walton Beach, FL 32547-6796

Phone

(850) 863-8100

Fax

(850) 862-6148

NPI assigned

Jul 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Bayne Jones Army Community Hospital

  • Family Medicine Physician
  • Niceville, FL
  • NPI 1831586312

  Internal Medicine

  NPD (past)
• Southern Inpatient Services Inc

  • Internal Medicine Physician
  • Birmingham, AL
  • NPI 1588731590
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324252800000",
    "number": "1255355731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 MAR WALT DRIVE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476796",
            "telephone_number": "850-863-8100",
            "fax_number": "850-862-6148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 MAR WALT DRIVE",
            "address_2": "INTERNAL MEDICINE DEPARTMENT",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476796",
            "telephone_number": "850-863-8100",
            "fax_number": "850-862-6148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PYBASS",
        "first_name": "PHILLIP",
        "middle_name": "ASHLEY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2011-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "00022083",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME111399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "510-04721",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009910483",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Publix Super Markets Inc (Publix Pharmacy #0766)
• Publix Super Markets Inc (Publix Pharmacy #0383)
• Amanda Jo Puett, APRN
• Lisa Diana Pugh, LPN
• Tara Jean Purcell, CRNA
• Melissa Munir Qaqish, LMHC
• Quality Primary Care PLLC (Quality Primary Care)
• Quality Urgent Care & Wellness PL
• Jessica Quick
• R Bradley Sheldon MD PA

• Internal Medicine Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, 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 Dec 19, 2011; 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.