NPIMap

Organization Active NPI

Life Management Center of Northwest Florida Inc

  • Psychiatry Physician
  • Blountstown, FL
National Provider Identifier
1659301877
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA INC
Practice address
16869 NE Pear St
Blountstown, FL 32424-1774
Phone
(850) 522-4480
Fax
(850) 914-6281
NPI assigned
Jul 4, 2006
Last updated
Apr 24, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 24, 2025

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

Authorized official

Name
Edwin Ailes
Title
Executive Director
Phone
(850) 522-4480

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

16869 NE Pear St
Blountstown, FL 32424-1774

Mailing address

525 E 15TH St
Panama City, FL 32405-5412
Phone (850) 522-4480

Other identifiers 1

IdentifierTypeStateIssuer
060296538MedicaidFL

Other names 1

  • Life Management Center of Northwest Florida Inc Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040612000387 FL Part B Supplier - Clinic/Group Practice 9739162371 Receives reassigned benefits from 27 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Blountstown, FL; Bonifay, FL; Marianna, FL; Panama City, FL; Port St Joe, FL

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Life Management Ctr of

Locations

16869 NE Pear St
Blountstown, FL 32424
Phone (850) 522-4485

310 E Byrd Ave
Bonifay, FL 32425
Phone (850) 522-4485

311 Williams Ave
Port St Joe, FL 32456
Phone (850) 522-4485

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 57

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.

View all 57

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745452800000",
    "number": "1659301877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E 15TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324055412",
            "telephone_number": "850-522-4480",
            "fax_number": "850-914-6281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16869 NE PEAR ST",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324241774",
            "telephone_number": "850-522-4480",
            "fax_number": "850-914-6281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA INC.",
        "enumeration_date": "2006-07-04",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A",
        "authorized_official_last_name": "AILES",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "850-522-4480"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060296538",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Management Center of Northwest Florida Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Blountstown, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.