Active NPI
Milton T. Mendenhall, M.D.
- Diagnostic Radiology Physician
- Saint Augustine, FL
National Provider Identifier
1477520435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- ME48034
- Practice address
- 400 Health Park Blvd
Attn: Radiology Department
Saint Augustine, FL 32086-5784 - Phone
- (904) 819-4398
- Fax
- (904) 819-4976
- NPI assigned
- Mar 8, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | ME48034 | FL | Primary |
Addresses
Primary practice location
400 Health Park Blvd
Attn: Radiology Department
Saint Augustine, FL 32086-5784
Mailing address
400 Health Park Blvd
Attn: Radiology Department
Saint Augustine, FL 32086-5784
Phone (904) 819-4398
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 272439100 | Medicaid | FL | |
| 300029640 | Other | FL | RAILROAD MEDICARE |
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 |
|---|---|---|---|
| ME48034 | FL | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339027200000",
"number": "1477520435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 HEALTH PARK BLVD",
"address_2": "ATTN: RADIOLOGY DEPARTMENT",
"city": "SAINT AUGUSTINE",
"state": "FL",
"postal_code": "320865784",
"telephone_number": "904-819-4398",
"fax_number": "904-819-4976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 HEALTH PARK BLVD",
"address_2": "ATTN: RADIOLOGY DEPARTMENT",
"city": "SAINT AUGUSTINE",
"state": "FL",
"postal_code": "320865784",
"telephone_number": "904-819-4398",
"fax_number": "904-819-4976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDENHALL",
"first_name": "MILTON",
"middle_name": "T.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-08",
"last_updated": "2012-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "FL",
"license": "ME48034",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "272439100",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "300029640",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.