Active NPI
Mark A. Newberry, M.D.
- Family Medicine Physician
- Havana, FL
National Provider Identifier
1487768511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- ME55545
- Practice address
- 602 E 5TH Ave
Havana, FL 32333-1442 - Phone
- (850) 539-4747
- Fax
- (850) 539-4744
- NPI assigned
- Aug 18, 2006
- 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 | ME55545 | FL | Primary |
Addresses
Primary practice location
602 E 5TH Ave
Havana, FL 32333-1442
Mailing address
602 E 5TH Ave
Havana, FL 32333-1442
Phone (850) 539-4747
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 061981700 | Medicaid | FL | |
| ME0055545 | Other | FL | STATE LICENSE NUMBER |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospital Authority of the City of Bainbridge and Decatur County | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Multi-Specialty Clinic/Center
- Bainbridge, GA
- NPI 1053388256
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731283200000",
"number": "1487768511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "602 E 5TH AVE",
"city": "HAVANA",
"state": "FL",
"postal_code": "323331442",
"telephone_number": "850-539-4747",
"fax_number": "850-539-4744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 E 5TH AVE",
"city": "HAVANA",
"state": "FL",
"postal_code": "323331442",
"telephone_number": "850-539-4747",
"fax_number": "850-539-4744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEWBERRY",
"first_name": "MARK",
"middle_name": "A.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-18",
"last_updated": "2024-11-11",
"certification_date": "2024-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "ME55545",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "061981700",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "ME0055545",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Havana, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.