Individual provider Active NPI

Twan Phanijphand, D.O.

  • Gastroenterology Physician
  • Fort Walton Beach, FL
National Provider Identifier
1790806248
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
OS16137 Issued in FL
Practice address
1326 Lewis Turner Blvd
Fort Walton Beach, FL 32547-1139
Phone
(850) 601-8177
Fax
(850) 862-0605
NPI assigned
Apr 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X OS16137 FL Primary
Gastroenterology Physician 207RG0100X 5101015350 MI
Gastroenterology Physician 207RG0100X 2010014123 MO

Addresses

Primary practice location

1326 Lewis Turner Blvd
Fort Walton Beach, FL 32547-1139

Mailing address

1326 Lewis Turner Blvd
Fort Walton Beach, FL 32547-1139
Phone (850) 601-8177

Other identifiers 1

IdentifierTypeStateIssuer
156440050OtherMOMEDICARE PTAN #

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20220728000612 FL Practitioner - GastroenterologyPractitioner - Internal Medicine 4385790930 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Emerald Coast Infectious Diseases Medical Group, P.a.Group PAC ID 5092753772, 35 clinicians

Practice addresses (Care Compare)

1326 Lewis Turner Blvd
Fort Walton Beach, FL 32547-1139
Phone (850) 855-4048

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.63 of 100Reported as individual
Quality
85.58
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy116
Upper gastrointestinal (GI) endoscopy for acid reflux254

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101015350MIMDGastroenterology Physician
2010014123MOMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emerald Coast Infectious Diseases Medical Group, PA CurrentSince Aug 1, 2025 Accepting new patients
Emerald Coast Infectious Diseases Medical Group, P.a. Gastroenterology CurrentSince Aug 1, 2025 Accepting new patients
Florida Trauma Services, LLC CurrentSince Jul 18, 2022 Accepting new patients

Locations

1326 Lewis Turner Blvd
Fort Walton Beach, FL 32547
Phone (850) 855-4048

320 Racetrack Rd NW
Ste 100B
Ft Walton Bch, FL 32547
Phone (850) 357-8151

917 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 862-3979

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Interoperability endpoints

  • Direct secure messaging: twan.phanijphand@hca5.eclinicaldirectplus.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 3

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": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1790806248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1326 LEWIS TURNER BLVD",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471139",
            "telephone_number": "850-601-8177",
            "fax_number": "850-862-0605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1326 LEWIS TURNER BLVD",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471139",
            "telephone_number": "850-601-8177",
            "fax_number": "850-862-0605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHANIJPHAND",
        "first_name": "TWAN",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "OS16137",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "5101015350",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "2010014123",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN #",
            "identifier": "156440050",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

Verify at the official NPI Registry.