Active NPI
Antonio Sison Vicencio III, M.D.
- Family Medicine Physician
- Palm Coast, FL
National Provider Identifier
1457474728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- ME89537
- Practice address
- 21 Hospital Dr
Suite 230
Palm Coast, FL 32164-2452 - Phone
- (386) 586-3466
- Fax
- (386) 586-3467
- NPI assigned
- Apr 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ME89537 | FL | Primary |
Addresses
Primary practice location
21 Hospital Dr
Suite 230
Palm Coast, FL 32164-2452
Mailing address
PO Box 354339
Palm Coast, FL 32135-4339
Phone (386) 586-3466
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43263 | Other | FL | BC/BS |
| 01156032 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME89537 | FL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emcare Physician Providers, Inc. | Past | Accepting new patients | |
| Adventhealth Primary Care Network Inc | Family Medicine | Past | Accepting new patients |
| Emcare Physician Providers, Inc. | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Family Medicine Physician
- Altamonte Springs, FL
- NPI 1093493637
-
- Emergency Medicine Physician
- Palm Coast, FL
- NPI 1063461838
-
- Emergency Medicine Physician
- Punta Gorda, FL
- NPI 1376592063
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279152000000",
"number": "1457474728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 354339",
"city": "PALM COAST",
"state": "FL",
"postal_code": "321354339",
"telephone_number": "386-586-3466",
"fax_number": "386-586-3467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 HOSPITAL DR",
"address_2": "SUITE 230",
"city": "PALM COAST",
"state": "FL",
"postal_code": "321642452",
"telephone_number": "386-586-3466",
"fax_number": "386-586-3467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICENCIO",
"first_name": "ANTONIO",
"middle_name": "SISON",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-09",
"last_updated": "2010-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "ME89537",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "43263",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01156032",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Palm Coast, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.