NPIMap

Individual provider Active NPI

Christopher Peter Paulson, M.D.

  • Family Medicine Physician
  • Fort Walton Beach, FL
National Provider Identifier
1265428171
Registry record updated Aug 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD-067176-L Issued in PA
Practice address
319 Green Acres Rd Ste 101
Fort Walton Beach, FL 32547
Phone
(508) 243-7681
Fax
(850) 243-0471
NPI assigned
Sep 26, 2005
Last updated
Aug 30, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD-067176-L PA Primary

Addresses

Primary practice location

319 Green Acres Rd Ste 101
Fort Walton Beach, FL 32547

Mailing address

319 Green Acres Rd Ste 101
Fort Walton Beach, FL 32547-1170
Phone (850) 243-7681

Other identifiers 1

IdentifierTypeStateIssuer
MD-067176-LOtherPAMEDICAL LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170720000065 FL Practitioner - Family Practice 2860647385 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Uniformed Services Uhs Fe Hebert School of Med, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Magnolia Medical Clinic P.a.Group PAC ID 8325185473, 12 clinicians

Practice addresses (Care Compare)

319 Green Acres Rd
Suite 101
Fort Walton Beach, FL 32547-1170
Phone (850) 243-7681

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions14
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD-067176-LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Magnolia Medical Clinic P.a. Family Medicine CurrentSince Aug 1, 2017 Accepting new patients
Magnolia Medical Clinic P.a. Family Medicine PastSince Mar 11, 2025 Accepting new patients

Locations

319 Green Acres Rd
#101
Ft Walton Bch, FL 32547
Phone (850) 243-0520

Interoperability endpoints

  • Direct secure messaging: christopher.paulson@mmcfp.directbygreenway.com
  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.60552

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535587200000",
    "number": "1265428171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 GREEN ACRES RD STE 101",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471170",
            "telephone_number": "850-243-7681",
            "fax_number": "850-243-0471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 GREEN ACRES RD STE 101",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "32547",
            "telephone_number": "508-243-7681",
            "fax_number": "850-243-0471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULSON",
        "first_name": "CHRISTOPHER",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2018-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD-067176-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "MD-067176-L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

Verify at the official NPI Registry.