NPIMap

Organization Active NPI

Gulf Coast Mobile Medical Care LLC

Doing business as Gulf Coast Mobile Medical Care

  • Family Medicine Physician
  • Pensacola Beach, FL
National Provider Identifier
1689330854
Registry record updated Feb 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GULF COAST MOBILE MEDICAL CARE LLC
Doing business as
Gulf Coast Mobile Medical Care
Practice address
471 Fort Pickens Rd
Pensacola Beach, FL 32561-2013
Phone
(850) 462-3131
Fax
(877) 370-4373
NPI assigned
Nov 12, 2021
Last updated
Feb 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2023

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

Authorized official

Name
Jake Wallstedt
Title
Partner
Phone
(615) 517-6009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

471 Fort Pickens Rd
Pensacola Beach, FL 32561-2013

Mailing address

471 Fort Pickens Rd
Gulf Breeze, FL 32561-2013

Other names 1

  • Gulf Coast Mobile Medical Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220114000258 FL Part B Supplier - Clinic/Group Practice 0446642813 Receives reassigned benefits from 10 practitioners
Practice locations: Gulf Breeze, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1636675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677110400000",
    "number": "1689330854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "471 FORT PICKENS RD",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325612013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "471 FORT PICKENS RD",
            "city": "PENSACOLA BEACH",
            "state": "FL",
            "postal_code": "325612013",
            "telephone_number": "850-462-3131",
            "fax_number": "877-370-4373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST MOBILE MEDICAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-12",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "WALLSTEDT",
        "authorized_official_first_name": "JAKE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "615-517-6009"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gulf Coast Mobile Medical Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pensacola Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; 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.