Individual provider Active NPI

Bruce Mitchell Yergin, M.D.

  • Pulmonary Disease Physician
  • Jacksonville, FL
National Provider Identifier
1619962230
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
ME0021067 Issued in FL
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

Updated by the provider on May 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
5362087OtherFLAETNA
78027OtherFLBLUE CROSS BLUE SHIELD
GR172AOtherFLMEDICARE - GROUP
215889OtherFLAVMED
0098365-00OtherFLFL MEDICAID - GROUP
PO1615058OtherFLRR MEDICARE
0141594-00MedicaidFL

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100827000083 FL Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 1153445135 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME0021067FLMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cisca Pulmonary Critical Care Inc Pulmonary Disease CurrentSince Feb 1, 2016 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

  • FHIR API: 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.

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

Verify at the official NPI Registry.