NPIMap

Organization Active NPI

Bayshore Anesthesia P a

  • Pain Medicine (Anesthesiology) Physician
  • Niceville, FL
National Provider Identifier
1659477461
Registry record updated Aug 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
ME69348 Issued in FL
Legal business name
BAYSHORE ANESTHESIA P A
Practice address
2190 Highway 85 N
Niceville, FL 32578-1045
Phone
(352) 867-8898
Fax
(352) 732-6282
NPI assigned
Sep 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2011

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

Authorized official

Name
Dr. Arthur Paul Broaderick, MDNPI 1922104678
Title
MD/President
Phone
(352) 867-8898

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X ME69348 FL Primary

Addresses

Primary practice location

2190 Highway 85 N
Niceville, FL 32578-1045

Mailing address

PO Box 7419
Orlando, FL 32891-7419
Phone (352) 867-8898

Other identifiers 2

IdentifierTypeStateIssuer
28253OtherFLBLUE CROSS BLUE SHIELD
379870400MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312848000000",
    "number": "1659477461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7419",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328917419",
            "telephone_number": "352-867-8898",
            "fax_number": "352-732-6282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2190 HIGHWAY 85 N",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325781045",
            "telephone_number": "352-867-8898",
            "fax_number": "352-732-6282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSHORE ANESTHESIA P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2011-08-09",
        "status": "A",
        "authorized_official_last_name": "BROADERICK",
        "authorized_official_first_name": "ARTHUR",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "MD/PRESIDENT",
        "authorized_official_telephone_number": "352-867-8898",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "FL",
            "license": "ME69348",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "28253",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "379870400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Niceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; 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.