NPIMap

Individual provider Active NPI

Gregory Mark Brown, M.D.

  • Internal Medicine Physician
  • Leesburg, FL
National Provider Identifier
1386647956
Registry record updated Apr 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME0058899 Issued in FL
Practice address
619 W Dixie Ave
Leesburg, FL 34748-2602
Phone
(352) 314-2424
Fax
(352) 314-3010
NPI assigned
May 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME0058899 FL Primary

Addresses

Primary practice location

619 W Dixie Ave
Leesburg, FL 34748-2602

Mailing address

619 W Dixie Ave
Leesburg, FL 34748-2602
Phone (352) 314-2424

Other identifiers 2

IdentifierTypeStateIssuer
054017000MedicaidFL
12567OtherFLBCBS PROVIDER NUMBER

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
I20100913000784 FL Practitioner - Internal Medicine 6002931177 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Yale University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

1550 Killingsworth Way
The Villages, FL 32162-2175
Phone (352) 633-2971

801 E Dixie Ave
Suite 107a
Leesburg, FL 34748-7601
Phone (352) 314-2424

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine Associates of Lake County, P.a. Internal Medicine CurrentSince Sep 1, 2000 Accepting new patients

Locations

619 W Dixie Ave
Leesburg, FL 34748
Phone (352) 314-2424

801 E Dixie Ave
Ste 107A
Leesburg, FL 34748
Phone (352) 314-2424

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AGEBDD
  • FHIR API: https://fhir4.healow.com/fhir/r4/AGEBDD/Endpoint/AGEBDD

Organizations & group practices 1

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 11

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": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427932800000",
    "number": "1386647956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 W DIXIE AVE",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347482602",
            "telephone_number": "352-314-2424",
            "fax_number": "352-314-3010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 W DIXIE AVE",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347482602",
            "telephone_number": "352-314-2424",
            "fax_number": "352-314-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "GREGORY",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2015-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0058899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054017000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "12567",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, FL

Sources for this page

Verify at the official NPI Registry.