Pensacola Lung Group, M.D.'S, P.a.
Organization Active NPI Specialist · Pensacola, FL
NPI 1619196151 · NPPES record last updated May 16, 2019
Key facts
- NPI
- 1619196151
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- PENSACOLA LUNG GROUP, M.D.'S, P.A.
- Practice address
- 4700 Bayou Blvd.
Suite 6
Pensacola, FL 32503 - Phone
- (850) 477-9253
- Fax
- (850) 494-9843
- NPI assigned
- Apr 24, 2007
- Organization subpart
- No
Authorized official
- Name
- April L. McDaniel
- Title
- Billing Supervisor
- Phone
- (850) 477-9253
Practitioners 39
-
Peter A Bercz, M.D.
-
John M Bray, M.D.
-
Aaron Brooks, DO
-
Lauren Barrett Evans, APRN
-
Tonya N Finney, APRN
-
Kristina A Gallagher, APRN
-
Jennifer Sanders Gordon, ARNP
-
Kelsey Christine Kvartek, APRN-C
-
Alicia Lanier, DNP
-
Cathy McGovern, APRN
-
Bijal Patel, DO
-
Tonya Kay Powell, ARNP
-
Justin Charles Reis, M.D.
-
Alejandro Restrepo, M.D.
-
Sean Michael Roark, M.D.
-
Jaimee Lauren Townsend, AGACNP
-
Aubri Rihan Velez, ARNP
-
Zachry Williams, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D0271071 | Pensacola Lung Group | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041019001056 | FL | Part B Supplier - Clinic/Group Practice | 7517928062 |
Receives reassigned benefits from 36 practitioners Practice locations: Pensacola, FL |
National Provider Directory
Locations
4700 Bayou Blvd
Ste 5
Pensacola, FL 32503
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
4700 Bayou Blvd.
Suite 6
Pensacola, FL 32503
Mailing address
4700 Bayou Blvd.
Suite 6
Pensacola, FL 32503
Phone (850) 477-9253
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 254412100 | Medicaid | FL |
Other providers in Pensacola, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.