NPIMap

Organization Active NPI

Life Management Center of NW FL, Inc.

  • Psychiatry Physician
  • Panama City, FL
National Provider Identifier
1508854571
Registry record updated May 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
LIFE MANAGEMENT CENTER OF NW FL, INC.
Practice address
525 East 15TH Street
Panama City, FL 32405-0000
Phone
(850) 522-4485
Fax
(850) 257-7967
NPI assigned
Oct 12, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2026

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

Authorized official

Name
Mr. Edwin R Ailes, LMFT
Title
Ceo/President
Phone
(850) 522-4485

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Community/Behavioral Health Agency 251S00000X
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

525 East 15TH Street
Panama City, FL 32405-0000

Mailing address

525 E 15TH St
Panama City, FL 32405-5412
Phone (850) 522-4485

Other identifiers 2

IdentifierTypeStateIssuer
99260OtherFLBLUE CROSS BLUE SHIELD
060296500MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040612000387 FL Part B Supplier - Clinic/Group Practice 9739162371 Receives reassigned benefits from 27 practitioners
4 other NPIs on this enrollment
Practice locations: Blountstown, FL; Bonifay, FL; Marianna, FL; Panama City, FL; Port St Joe, FL

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

310 E Byrd Ave
Bonifay, FL 32425
Phone (850) 522-4485

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778025600000",
    "number": "1508854571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E 15TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324055412",
            "telephone_number": "850-522-4485",
            "fax_number": "850-201-6024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 EAST 15TH STREET",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324050000",
            "telephone_number": "850-522-4485",
            "fax_number": "850-257-7967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE MANAGEMENT CENTER OF NW FL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A",
        "authorized_official_last_name": "AILES",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "850-522-4485",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "99260",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060296500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2026; 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.