Active NPI
Bruce Mitchell Yergin, M.D.
- Pulmonary Disease Physician
- Jacksonville, FL
National Provider Identifier
1619962230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- ME0021067
- Practice address
- 3627 University Blvd S Ste 300
Jacksonville, FL 32216 - Phone
- (904) 396-0300
- Fax
- (904) 396-3039
- NPI assigned
- Sep 20, 2005
- 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 |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | ME0021067 | FL | Primary |
Addresses
Primary practice location
3627 University Blvd S Ste 300
Jacksonville, FL 32216
Mailing address
1361 13TH Ave S Ste 245
Jacksonville Beach, FL 32250-3238
Phone (904) 396-0300
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5362087 | Other | FL | AETNA |
| 78027 | Other | FL | BLUE CROSS BLUE SHIELD |
| GR172A | Other | FL | MEDICARE - GROUP |
| 215889 | Other | FL | AVMED |
| 0098365-00 | Other | FL | FL MEDICAID - GROUP |
| PO1615058 | Other | FL | RR MEDICARE |
| 0141594-00 | Medicaid | 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0021067 | FL | MD | Pulmonary Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cisca Pulmonary Critical Care Inc | Pulmonary Disease | Current | Accepting new patients |
Locations
8773 Perimeter Park Ct
Jacksonville, FL 32216
Phone (904) 493-3390
3627 University Blvd S
Ste 300
Jacksonville, FL 32216
Phone (904) 396-0300
1361 13th Ave S
Ste 245
Jax Bch, FL 32250
Phone (904) 396-0300
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EHIDAD
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 and National Provider Directory roles.
-
- Pulmonary Disease Physician
- Jacksonville Beach, FL
- NPI 1629326285
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747785600000",
"number": "1619962230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1361 13TH AVE S STE 245",
"city": "JACKSONVILLE BEACH",
"state": "FL",
"postal_code": "322503238",
"telephone_number": "904-396-0300",
"fax_number": "904-396-3039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3627 UNIVERSITY BLVD S STE 300",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32216",
"telephone_number": "904-396-0300",
"fax_number": "904-396-3039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YERGIN",
"first_name": "BRUCE",
"middle_name": "MITCHELL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-20",
"last_updated": "2025-05-21",
"certification_date": "2025-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "FL",
"license": "ME0021067",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5362087",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "78027",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE - GROUP",
"identifier": "GR172A",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVMED",
"identifier": "215889",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FL MEDICAID - GROUP",
"identifier": "0098365-00",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "PO1615058",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0141594-00",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.