NPIMap

Individual provider Active NPI

Jackie W Westfall, DO

  • Family Medicine Physician
  • Deland, FL
National Provider Identifier
1740248152
Registry record updated Oct 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS5855 Issued in FL
Practice address
2370 E International Speedway Blvd
Deland, FL 32724-2744
Phone
(386) 736-1105
Fax
(386) 734-1443
NPI assigned
May 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OS5855 FL
Family Medicine Physician 207Q00000X OS5855 FL Primary

Addresses

Primary practice location

2370 E International Speedway Blvd
Deland, FL 32724-2744

Mailing address

2370 E International Speedway Blvd
Deland, FL 32724-2744
Phone (386) 736-1105

Other identifiers 2

IdentifierTypeStateIssuer
80464OtherFLBCBS PROVIDER NUMBER
054261000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS5855FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Florida Primary Care LLC Past Accepting new patients
4MD2 Physician Services of Fort Walton Beach LLC Emergency Medicine Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412985600000",
    "number": "1740248152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2370 E INTERNATIONAL SPEEDWAY BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327242744",
            "telephone_number": "386-736-1105",
            "fax_number": "386-734-1443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2370 E INTERNATIONAL SPEEDWAY BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327242744",
            "telephone_number": "386-736-1105",
            "fax_number": "386-734-1443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESTFALL",
        "first_name": "JACKIE",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2014-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "OS5855",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS5855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "80464",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054261000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.