NPIMap

Individual provider Active NPI

Dustin Matthew Lang, M.D.

  • Otolaryngology Physician
  • Jacksonville, FL
National Provider Identifier
1710366943
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
ME145918 Issued in FL
Practice address
3 Shircliff Way Ste 322
Jacksonville, FL 32204-4780
Phone
(904) 880-0911
Fax
(904) 880-9388
NPI assigned
May 20, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X ME145918 FL Primary

Addresses

Primary practice location

3 Shircliff Way Ste 322
Jacksonville, FL 32204-4780

Mailing address

11945 San Jose Blvd Ste 300
Jacksonville, FL 32223-1627
Phone (904) 396-1725

Other practice location 1

11705 San Jose Blvd Ste 103
Jacksonville, FL 32223-1653
Phone (904) 880-0911

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
I20200820001094 FL Practitioner - Otolaryngology 7618281247 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Florida Surgeons PAGroup PAC ID 2769381391, 336 clinicians

Practice addresses (Care Compare)

3 Shircliff Way
Suite 322
Jacksonville, FL 32204-4780
Phone (904) 384-8088

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.01 of 100Reported as individual
Quality
67.29
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Florida Surgeons, PA CurrentSince Aug 11, 2020 Accepting new patients
North Florida Surgeons, PA CurrentSince Aug 11, 2020 Accepting new patients

Locations

11945 San Jose Blvd
Ste 300
Jacksonville, FL 32223

11705 San Jose Blvd
Ste 103
Jacksonville, FL 32223
Phone (904) 880-0911

11945 San Jose Blvd
Ste 102
Jacksonville, FL 32223
Phone (904) 268-3937

3 Shircliff Way
Ste 322
Jacksonville, FL 32204
Phone (904) 384-8088

2 Shircliff Way
Ste 920
Jacksonville, FL 32204
Phone (904) 308-1380

Interoperability endpoints

  • Direct secure messaging: dustin.lang.1@9109.direct.athenahealth.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 7

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": "1432080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1710366943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11945 SAN JOSE BLVD STE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322231627",
            "telephone_number": "904-396-1725",
            "fax_number": "904-396-4893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 SHIRCLIFF WAY STE 322",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044780",
            "telephone_number": "904-880-0911",
            "fax_number": "904-880-9388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11705 San Jose Blvd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322231653",
            "country_code": "US",
            "telephone_number": "904-880-0911",
            "fax_number": "904-880-9388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANG",
        "first_name": "DUSTIN",
        "middle_name": "MATTHEW",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-20",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": "ME145918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.