NPIMap

Individual provider Active NPI

Mark James Elder, D.O.

  • Family Medicine Physician
  • Jay, FL
National Provider Identifier
1477559409
Registry record updated May 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS8505 Issued in FL
Practice address
3887 Scotts Plaza Dr
Jay, FL 32565-4001
Phone
(850) 981-0320
Fax
(850) 981-0911
NPI assigned
Jun 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS8505 FL Primary

Addresses

Primary practice location

3887 Scotts Plaza Dr
Jay, FL 32565-4001

Mailing address

3887 Scotts Plaza Dr
Jay, FL 32565-4001
Phone (850) 981-0320

Other identifiers 5

IdentifierTypeStateIssuer
263360638OtherFLTAX ID
590-48269OtherALBCBS
05247OtherFLBLUE CROSS FLORIDA
HS620AOtherFLMEDICARE GROUP PTAN
262643800MedicaidFL

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
I20080616000337 FL Practitioner - Family PracticePractitioner - Emergency Medicine 4981775160 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
R Franklin University of Med & Sci/Chicago Medical School, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Panhandle Rural Health Incorporated 5 clinicians

Practice addresses (Care Compare)

14088 Alabama St
Jay, FL 32565-1036
Phone (850) 675-4546

Hospital & facility affiliations

  • Amedisys Home Health Home health agency, Pensacola, FL, CCN 108309
  • D W McMillan Home Health Home health agency, Brewton, AL, CCN 017143
  • Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545
  • Jay Hospital Hospital, Jay, FL, CCN 101315
  • Sacred Heart Hospital Hospital, Pensacola, FL, CCN 100025
  • Santa Rosa Medical Center Hospital, Milton, FL, CCN 100124
  • Century Center for Rehabilitation and Healing Nursing home, Century, FL, CCN 105860
  • Jay Hospital Nursing home, CCN 10Z315

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
J S Michael Smith MD PA Family Medicine Current Accepting new patients
Jay Hospital, Inc. CurrentSince Oct 1, 2001 Accepting new patients
Jay Hospital, Inc. CurrentSince Oct 1, 2001 Accepting new patients
Jeffery S Kelley MD Current Accepting new patients
Panhandle Rural Health Incorporated CurrentSince Feb 1, 2017 Accepting new patients
Santa Rosa Hma Physician Management, LLC Family Medicine PastSince May 1, 2012 Accepting new patients
Physician Groups LC Family Medicine Past Accepting new patients
Santa Rosa Hma Urgent Care LLC Past Accepting new patients
Santa Rosa Hma Physician Management LLC Family Medicine PastSince Jul 4, 2021 Accepting new patients

Locations

8401 N Century Blvd
Century, FL 32535
Phone (850) 256-5314

14088 Alabama St
Jay, FL 32565
Phone (850) 675-4546

14114 Alabama St
Jay, FL 32565
Phone (850) 675-8000

Interoperability endpoints

  • Direct secure messaging: mark.elder@jaymedical.directbygreenway.com

Organizations & group practices 9

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.

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": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462320000000",
    "number": "1477559409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3887 SCOTTS PLAZA DR",
            "city": "JAY",
            "state": "FL",
            "postal_code": "325654001",
            "telephone_number": "850-981-0320",
            "fax_number": "850-981-0911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3887 SCOTTS PLAZA DR",
            "city": "JAY",
            "state": "FL",
            "postal_code": "325654001",
            "telephone_number": "850-981-0320",
            "fax_number": "850-981-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELDER",
        "first_name": "MARK",
        "middle_name": "JAMES",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2016-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS8505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "263360638",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "590-48269",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS FLORIDA",
            "identifier": "05247",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "HS620A",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "262643800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jay, FL

Sources for this page

Verify at the official NPI Registry.