Organization Active NPI

MD 2 Go LLC

  • Family Medicine Physician
  • Port Saint Lucie, FL
National Provider Identifier
1457696601
Registry record updated Nov 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MD 2 GO LLC
Practice address
1801 SE Hillmoor Dr
B109
Port Saint Lucie, FL 34952-7553
Phone
(772) 337-9473
Fax
(772) 337-0796
NPI assigned
Nov 29, 2012
Last updated
Nov 29, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2012

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

Authorized official

Name
Dwight G Dawkins, M.D.NPI 1164492005
Title
Owner
Phone
(772) 337-9473

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1801 SE Hillmoor Dr
B109
Port Saint Lucie, FL 34952-7553

Mailing address

1801 SE Hillmoor Dr
B109
Port Saint Lucie, FL 34952-7553
Phone (772) 337-9473

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130515000320 FL Part B Supplier - Clinic/Group Practice 1759528532 Receives reassigned benefits from 3 practitioners
Practice locations: Port Saint Lucie, FL

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1301 N Lawnwood Cir
Fort Pierce, FL 34950
Phone (772) 461-1191

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1354147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354147200000",
    "number": "1457696601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 SE HILLMOOR DR",
            "address_2": "B109",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527553",
            "telephone_number": "772-337-9473",
            "fax_number": "772-337-0796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 SE HILLMOOR DR",
            "address_2": "B109",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527553",
            "telephone_number": "772-337-9473",
            "fax_number": "772-337-0796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD 2 GO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-29",
        "last_updated": "2012-11-29",
        "status": "A",
        "authorized_official_last_name": "DAWKINS",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-337-9473",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.