Individual provider Active NPI

Vincent Todd Buckman, M.D.

  • Family Medicine Physician
  • Port Charlotte, FL
National Provider Identifier
1346248762
Registry record updated Nov 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME91222 Issued in FL
Practice address
21297 Olean Blvd Ste a
Port Charlotte, FL 33952-6704
Phone
(855) 979-5700
Fax
(855) 979-5701
NPI assigned
Jul 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME91222 FL Primary
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X ME91222 FL

Addresses

Primary practice location

21297 Olean Blvd Ste a
Port Charlotte, FL 33952-6704

Mailing address

2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774

Other identifiers 4

IdentifierTypeStateIssuer
52178OtherFLBCBS
P00284459OtherFLRAILROAD MEDICARE
271275000MedicaidFL
P01160582OtherFLRAILROAD MEDICARE

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
I20041207000687 FL Practitioner - Family Practice 7810953247 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

2315 Aaron St
Port Charlotte, FL 33952-5305
Phone (941) 613-2222

7374 San Casa Dr
Englewood, FL 34224-8842
Phone (941) 417-5064

Hospital & facility affiliations

  • Millennium Home Care LLC Home health agency, Port Charlotte, FL, CCN 109401
  • HCA Florida Fawcett Hospital Hospital, Port Charlotte, FL, CCN 100236

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME91222FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heron Springs Family Medicine Inc Family Medicine CurrentSince Jan 27, 2005 Accepting new patients
Millennium Physician Group LLC Family Medicine CurrentSince Mar 4, 2013 Accepting new patients
Millennium Physician Group LLC Family Medicine CurrentSince Mar 4, 2013 Accepting new patients
Hernando Family Practice Center Inc Past Accepting new patients
Hyperbaric & Woundcare Inc Undersea and Hyperbaric Medicine Past Accepting new patients
Hyperbaric & Woundcare Inc Undersea and Hyperbaric Medicine Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

2675 Winkler Ave
Fl 2
Fort Myers, FL 33901
Phone (855) 979-5700

3434 Hancock Bridge Pkwy
Ste 301
North Ft Myers, FL 33903
Phone 877856377411108

3434 Hancock Bridge Pkwy
North Ft Myers, FL 33903

2315 Aaron St
Port Charlotte, FL 33952
Phone (941) 613-2222

21297 Olean Blvd
#A
Pt Charlotte, FL 33952
Phone (855) 979-5700

2343 Aaron St
Pt Charlotte, FL 33952
Phone (855) 979-5700

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

8425 Balm St
Weeki Wachee, FL 34607
Phone (352) 238-7163

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 7

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.

Hospital & facility affiliations 2

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": "1120867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574380800000",
    "number": "1346248762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774",
            "fax_number": "239-599-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21297 OLEAN BLVD STE A",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526704",
            "telephone_number": "855-979-5700",
            "fax_number": "855-979-5701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKMAN",
        "first_name": "VINCENT",
        "middle_name": "TODD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-09",
        "last_updated": "2019-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME91222",
            "primary": true
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "FL",
            "license": "ME91222",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52178",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00284459",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "271275000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01160582",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.