Individual provider Active NPI

Michael L Lewis, MD

  • Obstetrics & Gynecology Physician
  • Bradenton, FL
National Provider Identifier
1265434542
Registry record updated Mar 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
ME44916 Issued in FL
Practice address
2318 Manatee Ave W
Bradenton, FL 34205-5432
Phone
(941) 714-7150
Fax
(941) 741-3242
NPI assigned
Jun 1, 2005
Last updated
Mar 24, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X ME44916 FL Primary

Addresses

Primary practice location

2318 Manatee Ave W
Bradenton, FL 34205-5432

Mailing address

700 8TH Ave W
Suite 101
Palmetto, FL 34221-4737
Phone (941) 776-4008

Other identifiers 2

IdentifierTypeStateIssuer
042377700MedicaidFL
30821OtherFLBCBS

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
I20040209000576 FL Practitioner - Obstetrics/Gynecology 2062306418 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME44916FLMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCR Health, Inc. CurrentSince Oct 16, 2014 Accepting new patients
MCR Health, Inc. CurrentSince Oct 16, 2014 Accepting new patients
North Broward Hospital District Past Accepting new patients
St Josephs Specialty Services Inc Past Accepting new patients

Locations

2318 Manatee Ave W
Bradenton, FL 34205
Phone (941) 714-7150

700 8th Ave W
Ste 101
Palmetto, FL 34221
Phone (941) 776-4008

12271 US Highway 301 N
Parrish, FL 34219
Phone (941) 713-2231

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490313600000",
    "number": "1265434542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 8TH AVE W",
            "address_2": "SUITE 101",
            "city": "PALMETTO",
            "state": "FL",
            "postal_code": "342214737",
            "telephone_number": "941-776-4008",
            "fax_number": "941-845-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2318 MANATEE AVE W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342055432",
            "telephone_number": "941-714-7150",
            "fax_number": "941-741-3242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "MICHAEL",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2017-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME44916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "042377700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "30821",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.