Gulf Coast Podiatry, PA

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

GULF COAST PODIATRY, PA

Practice address

2507 Harrison Ave Unit 201
Panama City, FL 32405-4447

Phone

(850) 769-0325

Fax

(850) 769-4476

NPI assigned

Aug 9, 2006

Organization subpart

No

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

Authorized official

Name

Shayne Jensen, DMDNPI 1134139454

Title

President

Phone

(850) 769-0325

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shayne Raymond Jensen, DPM, FACFAS

  • Foot & Ankle Surgery Podiatrist
  • Panama City, FL
  • NPI 1134139454
  Medicare reassignment Care Compare group NPD Authorized official
• Adam Joseph Peaden, DPM

  • Foot & Ankle Surgery Podiatrist
  • Panama City, FL
  • NPI 1407179856
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1295745560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2507 HARRISON AVE UNIT 201",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054447",
            "telephone_number": "850-769-0325",
            "fax_number": "850-769-4476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2507 HARRISON AVE UNIT 201",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054447",
            "telephone_number": "850-769-0325",
            "fax_number": "850-769-4476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST PODIATRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "SHAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-769-0325",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "45803",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CK8386",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gulf Coast Medical Center Primary Care LLC
• Gulf Coast Medical Doctors
• Gulf Coast Multispeciality Services, LLC
• Gulf Coast Pain Consultants LLC
• Gulf Coast Pest Control, Inc
• Gulf Coast Rehabilitation Center Inc
• Gulf Emergency Specialists PA
• Gulf Pharmacy Corp
• Lance E Gunning, MS, ATC, LAT, LPTA
• Ashish K Gupta, MD

• Foot & Ankle Surgery Podiatrist in Panama City, FL
• Providers in Panama City, FL by specialty
• Foot & Ankle Surgery Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.