NPIMap

Individual provider Active NPI

Timothy Jay Pursley, M.D.

  • Family Medicine Physician
  • Maitland, FL
National Provider Identifier
1376646562
Registry record updated Jan 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME69464 Issued in FL
Practice address
402 Lake Howell Rd
Maitland, FL 32751-5907
Phone
(407) 628-4312
Fax
(407) 628-1845
NPI assigned
Sep 6, 2006
Last updated
Jan 19, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2022

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 ME69464 FL Primary

Addresses

Primary practice location

402 Lake Howell Rd
Maitland, FL 32751-5907

Mailing address

402 Lake Howell Rd
Maitland, FL 32751-5907
Phone (407) 628-4312

Other identifiers 1

IdentifierTypeStateIssuer
252196200MedicaidFL

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
I20100921001241 FL Practitioner - Family Practice 5294804670 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Family Medicine CurrentSince Dec 20, 2021 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Dec 20, 2021 Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

402 Lake Howell Rd
Maitland, FL 32751
Phone (407) 628-4312

Interoperability endpoints

  • Direct secure messaging: timothypursley@mfpfl.allscriptsdirect.net
  • Direct secure messaging: tpursley131443@adventhealth.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Uchicago Medicine Adventhealth BolingbrookBolingbrook, IL, CCN 140304 Hospital Corporate Director Jun 6, 2024
Uchicago Medicine Adventhealth la GrangeLa Grange, IL, CCN 140065 Hospital Corporate Director Jun 6, 2024
Uchicago Medicine Adventhealth la GrangeLa Grange, IL, CCN 14T065 Hospital Corporate Director Jun 6, 2024
Uchicago Medicine Adventhealth BolingbrookBolingbrook, IL, CCN 14S304 Hospital Corporate Director Jun 6, 2024
Uchicago Medicine Adventhealth GlenoaksGlendale Heights, IL, CCN 140292 Hospital Corporate Director Jun 6, 2024
Uchicago Medicine Adventhealth HinsdaleHinsdale, IL, CCN 14S122 Hospital Corporate Director Jun 6, 2024
Uchicago Medicine Adventhealth HinsdaleHinsdale, IL, CCN 140122 Hospital Corporate Director Jun 6, 2024
Uchicago Medicine Adventhealth Home CareLa Grange, IL, CCN 147207 Home health agency Corporate Director Jun 6, 2024
Adventist St Thomas HospiceHinsdale, IL, CCN 141507 Hospice Corporate Director Jun 6, 2024

Owned or controlled facilities with NPI records 10

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1376646562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 LAKE HOWELL RD",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515907",
            "telephone_number": "407-628-4312",
            "fax_number": "407-628-1845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 LAKE HOWELL RD",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515907",
            "telephone_number": "407-628-4312",
            "fax_number": "407-628-1845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PURSLEY",
        "first_name": "TIMOTHY",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME69464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252196200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

Verify at the official NPI Registry.