NPIMap

Individual provider Active NPI

Michael Vincent Florendo Tablang, M.D.

  • Infectious Disease Physician
  • Crestview, FL
National Provider Identifier
1679763387
Registry record updated Feb 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
ME138845 Issued in FL
Practice address
351 N Ferdon Blvd
Crestview, FL 32536-2727
Phone
(508) 623-9798
Fax
(850) 862-0605
NPI assigned
Jul 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 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 ME138845 FL Primary

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

Other identifiers 1

IdentifierTypeStateIssuer
116653900MedicaidFL

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
I20190401000180 FL Practitioner - Infectious DiseasePractitioner - Internal Medicine 7113173279 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Other, 1998
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)

351 N Ferdon Blvd
Crestview, FL 32536-2727
Phone 85086239792

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Shalimar, FL, CCN 107240
  • North Okaloosa Medical Center Hospital, Crestview, FL, CCN 100122
  • HCA Florida Fort Walton-Destin Hospital Hospital, Fort Walton Beach, FL, CCN 100223
  • HCA Florida Twin Cities Hospital Hospital, Niceville, FL, CCN 100054
  • Baptist Hospital Hospital, Pensacola, FL, CCN 100093
  • Sacred Heart Hospital on the Emerald Coast Hospital, Miramar Beach, FL, CCN 100292

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue935
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emerald Coast Infectious Diseases Medical Group, PA CurrentSince May 1, 2019 Accepting new patients
Emerald Coast Infectious Diseases Medical Group, P.a. Infectious Disease CurrentSince May 1, 2019 Accepting new patients

Locations

351 N Ferdon Blvd
Crestview, FL 32536
Phone (850) 862-3979

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

Interoperability endpoints

  • Direct secure messaging: mtablang@yourcarecommunity.org
  • Direct secure messaging: mtablang201315@ahs.direct-ci.com

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1185667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707868800000",
    "number": "1679763387",
    "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",
            "fax_number": "850-862-0605"
        },
        {
            "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": "508-623-9798",
            "fax_number": "850-862-0605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABLANG",
        "first_name": "MICHAEL VINCENT",
        "middle_name": "FLORENDO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-29",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "FL",
            "license": "ME138845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116653900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview, FL

Sources for this page

Verify at the official NPI Registry.