NPIMap

Individual provider Active NPI

Michael J Annunziata, MD

  • Emergency Medicine Physician
  • Englewood, FL
National Provider Identifier
1619080165
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
084156 Issued in FL
Practice address
1676 New Point Comfort Rd
Englewood, FL 34223-4878
Phone
(770) 841-1520
NPI assigned
Aug 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 050123 GA
Emergency Medicine Physician 207P00000X 084156 FL Primary

Addresses

Primary practice location

1676 New Point Comfort Rd
Englewood, FL 34223-4878

Mailing address

1676 New Point Comfort Rd
Englewood, FL 34223-4878
Phone (770) 841-1520

Other practice location 1

3950 Austell Rd
Austell, GA 30106-1121
Phone (770) 732-4000

Other identifiers 2

IdentifierTypeStateIssuer
000975895CMedicaidGA
000975895DMedicaidGA

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

State licenses

LicenseStateTypeSpecialty
084156FLMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kinston Physicians Group, PLLC Emergency Medicine PastSince Apr 19, 2020 Accepting new patients
Eastern Kentucky Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
The Bortolazzo Group, LLC Emergency Medicine PastSince Feb 9, 2020 Accepting new patients
Ohio Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Florida Em-I Medical Services PA Emergency Medicine Past Accepting new patients
North Florida Emergency Physicians Emergency Medicine Past Accepting new patients
Gulf Coast Emergency Physicians PA Emergency Medicine Past Accepting new patients
Florida Em-I Medical Services, PA Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1619080165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1676 NEW POINT COMFORT RD",
            "city": "ENGLEWOOD",
            "state": "FL",
            "postal_code": "342234878",
            "telephone_number": "770-841-1520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1676 NEW POINT COMFORT RD",
            "city": "ENGLEWOOD",
            "state": "FL",
            "postal_code": "342234878",
            "telephone_number": "770-841-1520"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3950 Austell Rd",
            "address_purpose": "LOCATION",
            "city": "Austell",
            "state": "GA",
            "postal_code": "301061121",
            "country_code": "US",
            "telephone_number": "770-732-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANNUNZIATA",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2020-10-15",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "050123",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "084156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000975895C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000975895D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.