NPIMap

Organization Active NPI

Emerald Coast Infectious Diseases Medical Group, P.a.

  • Durable Medical Equipment & Medical Supplies
  • Crestview, FL
National Provider Identifier
1649079351
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP, P.A.
Practice address
351 N Ferdon Blvd
Crestview, FL 32536-2727
Phone
(850) 862-3979
NPI assigned
Mar 13, 2025
Last updated
Mar 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

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

Authorized official

Name
Kelley Gear
Title
Assistant Practice Manager
Phone
(850) 862-3979

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

351 N Ferdon Blvd
Crestview, FL 32536-2727

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Emerald Coast Infectious Diseases Medical Group PA7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1741824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741824000000",
    "number": "1649079351",
    "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": "351 N FERDON BLVD",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325362727",
            "telephone_number": "850-862-3979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-13",
        "last_updated": "2025-03-13",
        "certification_date": "2025-02-27",
        "status": "A",
        "authorized_official_last_name": "GEAR",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "ASSISTANT PRACTICE MANAGER",
        "authorized_official_telephone_number": "850-862-3979"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; 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.