Institute of Internal Medicine P a

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME76599 Issued in FL

Legal business name

INSTITUTE OF INTERNAL MEDICINE P A

Practice address

1301 Plantation Island Dr S
Ste 402B
St Augustine, FL 32080-3108

Phone

(904) 460-0707

NPI assigned

Mar 24, 2008

Last updated

Sep 15, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Carmen C Vivero, MDNPI 1316012743

Title

President

Phone

(904) 460-0707

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carmen C Vivero, M.D.

  • Addiction Medicine (Internal Medicine) Physician
  • St Augustine, FL
  • NPI 1316012743
  Authorized official Same address or phone

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

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316044800000",
    "number": "1457523003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DR S",
            "address_2": "STE 402-B",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320803108",
            "telephone_number": "904-460-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DR S",
            "address_2": "STE 402B",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320803108",
            "telephone_number": "904-460-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE OF INTERNAL MEDICINE P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-24",
        "last_updated": "2011-09-15",
        "status": "A",
        "authorized_official_last_name": "VIVERO",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-460-0707",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME76599",
            "primary": true
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "FL",
            "license": "ME76599",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DN9360",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "44784",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003271700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.