Eleonora Hackman-Kerbyson, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME104987 Issued in FL

Practice address

2450 Tamiami TRL
Ste a
Port Charlotte, FL 33952-3922

Phone

(941) 624-2704

Fax

(941) 627-6066

NPI assigned

Jun 12, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 6

Other names 1

• Eleonora Hackman Professional name

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

87.29 of 100Reported as group

Quality

76.46

Improvement activities

40

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Main Street Emergency Group LLC

  • Emergency Medicine Physician
  • New Iberia, LA
  • NPI 1750796041
  Medicare reassignment NPD
• Teche Emergency Group LLC

  • Emergency Medicine Physician
  • Franklin, LA
  • NPI 1356658884
  Medicare reassignment NPD
• Alton-Griffin Emergency Group PC

  • Emergency Medicine Physician
  • Alton, IL
  • NPI 1891104824
  NPD (past)
• Crystal City Emergency Services, LLC

  • Nurse Practitioner
  • Crystal City, MO
  • NPI 1801844618

  Emergency Medicine

  NPD (past)
• Kennekuk Emergency Physicians LLC

  • Emergency Medicine Physician
  • Danville, IL
  • NPI 1659523777
  NPD (past)
• Mercy Hospital South

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1568481984

  Emergency Medicine

  NPD (past)
• Southeastern Emergency Physicians of Memphis LLC

  • Emergency Medicine Physician
  • Pleasanton, CA
  • NPI 1114309168
  NPD (past)
• Southeastern Emergency Physicians of Memphis LLC

  • Emergency Medicine Physician
  • Alton, IL
  • NPI 1437105277
  NPD (past)
• Tenet Healthsystem Di, Inc.

  dba Des Peres Hospital

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1104857994
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392854400000",
    "number": "1720020852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 HANCOCK BRIDGE PKWY",
            "address_2": "STE 301",
            "city": "N FORT MYERS",
            "state": "FL",
            "postal_code": "339037094",
            "telephone_number": "877-856-3774",
            "fax_number": "239-599-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 TAMIAMI TRL",
            "address_2": "STE A",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339523922",
            "telephone_number": "941-624-2704",
            "fax_number": "941-627-6066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKMAN-KERBYSON",
        "first_name": "ELEONORA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2014-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2003014738",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-110911",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME104987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "426403",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "124884",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208440818",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY HEALTH",
            "identifier": "947071631",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00145175",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036110911",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELEONORA",
            "last_name": "HACKMAN",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Gulfview Medical Institute PLLC
• Lisa Guttman, APRN
• Raquel Teresa Guzman
• GV Port Charlotte, LLC (Grand Villa of Port Charlotte)
• Gydl Enterprise
• Jake Richard Hager, M.D.
• Pouria Haghighi Tajvar, M.D.
• Hak Get Well Inc (Get Well Therapy)
• Steven P Halasz, MD
• Becky Halbert, LMHC

• Internal Medicine Physician in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.