Philip A Davidson, MEDICAL DOCTOR

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

ME54865 Issued in FL

Practice address

2200 Park Ave BLDG D
Ste 100
Park City, UT 84060-7246

Phone

(435) 615-8822

Fax

(435) 615-8823

NPI assigned

Nov 17, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2015 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/5077/brand/3/csg/61/fhir/r4

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.

• Davidson Orthopedics LLC

  • Orthopaedic Surgery Physician
  • Salt Lake City, UT
  • NPI 1821468109
  NPD (past)
• Florida Musculoskeletal Surgical Group LLC

  • Orthopaedic Surgery Physician
  • St Petersburg, FL
  • NPI 1073850160
  NPD (past)
• Tampa Bay Orthopaedic Specialists

  • Orthopaedic Surgery Physician
  • Pinellas Park, FL
  • NPI 1255313425
  NPD (past)

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349049600000",
    "number": "1528040367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 PARK AVE BLDG D",
            "address_2": "STE 100",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840607246",
            "telephone_number": "435-615-8822",
            "fax_number": "435-615-8823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 PARK AVE BLDG D",
            "address_2": "STE 100",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840607246",
            "telephone_number": "435-615-8822",
            "fax_number": "435-615-8823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "PHILIP",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MEDICAL DOCTOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2012-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "FL",
            "license": "ME54865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "2000016351",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4511587",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "258113",
            "identifier": "AVMED",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "18987",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "373524900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corey Cutler, F.N.P.
• Leslie Gudrun Czerwinski, ACMHC
• Lisa Dagostinosilverstein, CSW
• Mitchell Dahl, PA-C
• Rhonda Dameron, OTR/L
• Julie Davis, FNP-C
• Stefani Jane Day, MD
• Mohammad M. Dbeisi I, MD
• Alison Janine Delgado, M.D.
• Dell Center

• Sports Medicine (Orthopaedic Surgery) Physician in Park City, UT
• Providers in Park City, UT by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.