NPIMap

Individual provider Active NPI

Jeffrey Lin, D.O.

  • Infectious Disease Physician
  • Fort Walton Beach, FL
National Provider Identifier
1639622665
Registry record updated May 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
OS17605 Issued in FL
Practice address
917 Mar Walt Dr
Fort Walton Beach, FL 32547-6651
Phone
(850) 862-3979
NPI assigned
Jul 26, 2016
Last updated
May 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X OS17605 FL Primary

Addresses

Primary practice location

917 Mar Walt Dr
Fort Walton Beach, FL 32547-6651

Mailing address

917 Mar Walt Dr
Fort Walton Beach, FL 32547-6651
Phone (850) 862-3979

Other practice location 1

2000 Eoff St
Wheeling, WV 26003-3823
Phone (304) 234-8177

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210520002365 FL Practitioner - Infectious Disease 8820386030 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious Disease
Education
Philadelphia College of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Emerald Coast Infectious Diseases Medical Group, P.a.Group PAC ID 5092753772, 35 clinicians

Practice addresses (Care Compare)

917 Mar Walt Dr
Fort Walton Beach, FL 32547-6651
Phone (850) 862-3979

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue770
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emerald Coast Infectious Diseases Medical Group, PA CurrentSince Jul 1, 2021 Accepting new patients
Emerald Coast Infectious Diseases Medical Group, P.a. Infectious Disease CurrentSince Jul 1, 2021 Accepting new patients

Locations

917 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 862-3979

Interoperability endpoints

  • Direct secure messaging: jlin24671@ukhcdirect.org

Organizations & group practices 2

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1469491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714867200000",
    "number": "1639622665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476651",
            "telephone_number": "850-862-3979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476651",
            "telephone_number": "850-862-3979"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Eoff St",
            "address_purpose": "LOCATION",
            "city": "Wheeling",
            "state": "WV",
            "postal_code": "260033823",
            "country_code": "US",
            "telephone_number": "304-234-8177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIN",
        "first_name": "JEFFREY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-26",
        "last_updated": "2024-05-05",
        "certification_date": "2024-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "FL",
            "license": "OS17605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

Verify at the official NPI Registry.