Luis M Anderson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME0089595 Issued in FL

Practice address

3670 US 1 S Ste 300B
Saint Augustine, FL 32086-6354

Phone

(904) 479-9501

Fax

(904) 217-0524

NPI assigned

Jan 2, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Christian Family Medicine, LLC

  • Family Medicine Physician
  • Ripley, TN
  • NPI 1043252620
  Medicare reassignment NPD
• Dyersburg Family Walk-in Clinic LLC

  • Rural Health Clinic/Center
  • Dyersburg, TN
  • NPI 1174712780
  Medicare reassignment NPD
• Community Care Pediatrics PA

  • Primary Care Clinic/Center
  • Saint Augustine, FL
  • NPI 1639437569

  Pediatrics

  NPD Authorized official
• Christian Family Medicine

  • Family Nurse Practitioner
  • Ripley, TN
  • NPI 1720338833
  NPD
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)
• Independent Radiology Associates PLC

  • Diagnostic Radiology Physician
  • Dyersburg, TN
  • NPI 1194804906
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580515200000",
    "number": "1649337635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3670 US 1 S STE 300B",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320866354",
            "telephone_number": "904-479-9501",
            "fax_number": "904-217-0524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3670 US 1 S STE 300B",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320866354",
            "telephone_number": "904-479-9501",
            "fax_number": "904-217-0524"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "885 State Road 20",
            "address_purpose": "LOCATION",
            "city": "Interlachen",
            "state": "FL",
            "postal_code": "321482430",
            "country_code": "US",
            "telephone_number": "863-643-0400",
            "fax_number": "386-350-0398",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "LUIS",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2020-02-01",
        "certification_date": "2020-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME0089595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "37560",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269304600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7201378",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "650598984",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ancient City Pediatrics
• And Then There Is You for North Florida PLLC
• Megan E Andersen, APRN
• Geneva J Anderson
• Jasmine Anderson
• Marcus Walter Anderson, M.D.
• Stephen Anderson
• Tayler Breanne Anderson, LMT
• William Anderson II, ROH
• Andrea Levinson

• Pediatrics Physician in Saint Augustine, FL
• Providers in Saint Augustine, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2020; 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.

Verify at the official NPI Registry.