Individual provider Active NPI

Dale Thomas Landry Jr., M.D.

  • Orthopaedic Surgery Physician
  • Fort Walton Beach, FL
National Provider Identifier
1518108588
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
ME123092 Issued in FL
Practice address
1034 Mar Walt Dr
Suite 100
Fort Walton Beach, FL 32547-6639
Phone
(850) 863-2153
Fax
(850) 315-9350
NPI assigned
Mar 20, 2009
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X ME123092 FL Primary
Orthopaedic Surgery of the Spine Physician 207XS0117X ME 123092 FL

Addresses

Primary practice location

1034 Mar Walt Dr
Suite 100
Fort Walton Beach, FL 32547-6639

Mailing address

1034 Mar Walt Dr
Suite 100
Fort Walton Beach, FL 32547-6639
Phone (850) 863-2153

Other identifiers 4

IdentifierTypeStateIssuer
ME123092OtherFLMEDICAL LICENSE
APPLYING ATN 598515OtherFLFL MEDICAID
Z170402OtherMEDICARE PTAN
151CHOtherFLBCBS FL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150821013344 FL Practitioner - Orthopedic Surgery 7911128863 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Louisiana State University School of Medicine in New Orleans, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Florida Surgeons PAGroup PAC ID 2769381391, 336 clinicians

Practice addresses (Care Compare)

1034 Mar Walt Dr
Fort Walton Beach, FL 32547-6645
Phone (850) 344-1646

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.79 of 100Reported as group
Quality
64.42
Promoting interoperability
100
Improvement activities
40
Cost
74.88

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 123092FLMDOrthopaedic Surgery of the Spine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Associates PA Orthopaedic Surgery CurrentSince Sep 1, 2015 Accepting new patients
Orthopaedic Associates, PA Orthopaedic Surgery CurrentSince Sep 1, 2015 Accepting new patients
North Florida Surgeons, PA Orthopaedic Surgery CurrentSince May 19, 2024 Accepting new patients
North Florida Surgeons, PA CurrentSince May 19, 2024 Accepting new patients
Orthopaedic Associates PA Orthopaedic Surgery Past Accepting new patients

Locations

5300 S Ferdon Blvd
Crestview, FL 32536
Phone (850) 344-1646

36468 Emerald Coast Pkwy
Ste 1101
Destin, FL 32541
Phone (850) 290-2154

36474C Emerald Coast Pkwy
Ste 3101
Destin, FL 32541
Phone (850) 344-1646

1340 S 18th St
Ste 104
Fernandina Beach, FL 32034
Phone (904) 277-3277

1034 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 344-1646

1034 Mar Walt Dr
Unit 100
Ft Walton Bch, FL 32547
Phone (850) 315-9210

11945 San Jose Blvd
Ste 102
Jacksonville, FL 32223
Phone (904) 268-3937

554 Twin Cities Blvd
Ste D
Niceville, FL 32578
Phone (850) 315-9210

Interoperability endpoints

  • Direct secure messaging: dale.landry.1@9109.direct.athenahealth.com
  • Direct secure messaging: dlandry@direct.orthoassociates.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1237507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1518108588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 MAR WALT DR",
            "address_2": "SUITE 100",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476639",
            "telephone_number": "850-863-2153",
            "fax_number": "850-315-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 MAR WALT DR",
            "address_2": "SUITE 100",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476639",
            "telephone_number": "850-863-2153",
            "fax_number": "850-315-9350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDRY",
        "first_name": "DALE",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "FL",
            "license": "ME123092",
            "primary": true
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "FL",
            "license": "ME 123092",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME123092",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL MEDICAID",
            "identifier": "APPLYING ATN 598515",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z170402",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL",
            "identifier": "151CH",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

Verify at the official NPI Registry.