NPIMap

Individual provider Active NPI

Henry Dewitt Rodeffer, M.D.

  • Internal Medicine Physician
  • Fernandina Beach, FL
National Provider Identifier
1710978077
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME 46565 Issued in FL
Practice address
1132 S 14TH St
Fernandina Beach, FL 32034-2920
Phone
(904) 432-3061
Fax
(904) 432-3062
NPI assigned
Nov 4, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME 46565 FL Primary

Addresses

Primary practice location

1132 S 14TH St
Fernandina Beach, FL 32034-2920

Mailing address

2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774

Other identifiers 2

IdentifierTypeStateIssuer
14101OtherFLBCBS
L1249OtherFLMEDICARE

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
I20040520000634 FL Practitioner - Internal Medicine 0042201816 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of South Florida College of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians

Practice addresses (Care Compare)

1132 S 14TH St
Fernandina Beach, FL 32034-2920
Phone (904) 277-4690

Hospital & facility affiliations

  • Brooks Rehabilitation Home Health Home health agency, Jacksonville, FL, CCN 103174
  • Baptist Home Health Care by Bayada Home health agency, Jacksonville, FL, CCN 107482
  • Concierge Home Care Home health agency, Jacksonville, FL, CCN 687131
  • Welcome Homecare Home health agency, Jacksonville, FL, CCN 107436
  • Centerwell Home Health Home health agency, Jacksonville, FL, CCN 107687
  • Community Hospice of Northeast Florida Inc Hospice, Jacksonville, FL, CCN 101500
  • Baptist Medical Center - Nassau Hospital, Fernandina Beach, FL, CCN 100140
  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 46565FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC Internal Medicine CurrentSince Nov 11, 2019 Accepting new patients
Millennium Physician Group LLC CurrentSince Nov 11, 2019 Accepting new patients
Southern Baptist Hospital of Florida Inc Past Accepting new patients

Locations

14540 Cortez Blvd
Ste 102
Brooksville, FL 34613
Phone (352) 596-7255

1250 S 18th St
Fernandina Beach, FL 32034
Phone (904) 202-2087

1250 S 18th St
Ste 202
Fernandina Beach, FL 32034
Phone (904) 202-2000

1132 S 14th St
Fernandina Beach, FL 32034
Phone (904) 277-4690

2675 Winkler Ave
Fl 2
Fort Myers, FL 33901
Phone (855) 979-5700

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

Interoperability endpoints

  • Direct secure messaging: henry.rodeffer.1@4290.direct.athenahealth.com

Organizations & group practices 3

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 10

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": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1710978077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1132 S 14TH ST",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320342920",
            "telephone_number": "904-432-3061",
            "fax_number": "904-432-3062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODEFFER",
        "first_name": "HENRY",
        "middle_name": "DEWITT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-04",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME 46565",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "14101",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "L1249",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fernandina Beach, FL

Sources for this page

Verify at the official NPI Registry.