NPIMap

Individual provider Active NPI

Gerald Wayne Skipper Jr., M.D.

  • Family Medicine Physician
  • Blountstown, FL
National Provider Identifier
1275507170
Registry record updated Feb 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME71226 Issued in FL
Practice address
17808 NE Charlie Johns St
Blountstown, FL 32424-1052
Phone
(850) 674-4524
Fax
(850) 674-2300
NPI assigned
Feb 15, 2006
Last updated
Feb 29, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2016

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 ME71226 FL Primary

Addresses

Primary practice location

17808 NE Charlie Johns St
Blountstown, FL 32424-1052

Mailing address

17808 NE Charlie Johns St
Blountstown, FL 32424-1052
Phone (850) 674-4524

Other identifiers 1

IdentifierTypeStateIssuer
254802000MedicaidFL

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
I20080128000173 FL Practitioner - Family PracticePractitioner - Emergency Medicine 5294817409 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
University of Florida College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

17808 NE Charlie Johns St
TMH Physician Partners Blountstown
Blountstown, FL 32424-1052
Phone (850) 674-4524

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tallahassee Memorial Healthcare Inc Current Accepting new patients
Tallahassee Memorial Healthcare Inc Current Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Tallahassee Memorial Healthcare Inc Family Medicine Past Accepting new patients
Dassee Community Health Systems Past Accepting new patients

Locations

1300 Miccosukee Rd
Tallahassee, FL 32308
Phone (850) 431-1155

1607 Saint James Ct
Ste 1
Tallahassee, FL 32308
Phone (850) 431-7021

Interoperability endpoints

  • Direct secure messaging: geraldskipper@tmhpp.allscriptsdirect.net
  • Direct secure messaging: gskipper22282@tallahasseememorial.direct-ci.com

Organizations & group practices 5

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 9

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": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456704000000",
    "number": "1275507170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17808 NE CHARLIE JOHNS ST",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324241052",
            "telephone_number": "850-674-4524",
            "fax_number": "850-674-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17808 NE CHARLIE JOHNS ST",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324241052",
            "telephone_number": "850-674-4524",
            "fax_number": "850-674-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKIPPER",
        "first_name": "GERALD",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2016-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME71226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254802000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blountstown, FL

Sources for this page

Verify at the official NPI Registry.