Active NPI
Anthony Alan Anderson
- Case Manager/Care Coordinator
- Mascotte, FL
National Provider Identifier
1548723356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- 022905700
- Practice address
- 55 Bluff Lake Rd
Mascotte, FL 34753-9536 - Phone
- (352) 460-6093
- Fax
- (352) 366-0230
- NPI assigned
- Apr 9, 2019
- Last updated
- Apr 9, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 022905700 | FL | Primary |
Addresses
Primary practice location
55 Bluff Lake Rd
Mascotte, FL 34753-9536
Mailing address
15508 Willet CT
Mascotte, FL 34753-9102
Phone (523) 460-6093
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 022905700 | Medicaid | FL |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022905700 | FL | MD | Case Manager/Care Coordinator |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Redefining Abilities LLC | Case Manager/Care Coordinator | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554768000000",
"number": "1548723356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15508 WILLET CT",
"city": "MASCOTTE",
"state": "FL",
"postal_code": "347539102",
"telephone_number": "523-460-6093",
"fax_number": "352-366-0230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 BLUFF LAKE RD",
"city": "MASCOTTE",
"state": "FL",
"postal_code": "347539536",
"telephone_number": "352-460-6093",
"fax_number": "352-366-0230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "ANTHONY",
"middle_name": "ALAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-09",
"last_updated": "2019-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "FL",
"license": "022905700",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "022905700",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mascotte, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.