Individual provider Active NPI

Elizabeth B Fudge, M.D.

  • Pediatric Endocrinology Physician
  • Gainesville, FL
National Provider Identifier
1801009782
Registry record updated Dec 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X
License
ME108315 Issued in FL
Practice address
1600 SW Archer Rd
Gainesville, FL 32610-3003
Phone
(352) 334-1390
Fax
(352) 334-1325
NPI assigned
May 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Endocrinology Physician 2080P0205X 2005-01246 NC
Pediatric Endocrinology Physician 2080P0205X ME108315 FL Primary

Addresses

Primary practice location

1600 SW Archer Rd
Gainesville, FL 32610-3003

Mailing address

PO Box 918025
Orlando, FL 32891-8025
Phone (352) 334-1390

Other identifiers 1

IdentifierTypeStateIssuer
002840300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20231030000547 SC Practitioner - Pediatric Medicine 1759309495 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Medical College of Georgia School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

167 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

Merit-based Incentive Payment System (MIPS)

Final score
79.02 of 100Reported as group
Quality
62.41
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2005-01246NCMDPediatric Endocrinology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Nov 15, 2010 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Nov 1, 2023 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Nov 15, 2010 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Nov 1, 2023 Accepting new patients

Locations

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

1701 SW 16th Ave
Bldg A
Gainesville, FL 32608
Phone (352) 334-0206

10 McClennan Banks Dr
Charleston, SC 29401
Phone (843) 330-9824

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

2250 Mall Dr
North Charleston, SC 29406
Phone (843) 876-0199

Interoperability endpoints

  • Direct secure messaging: efudge446830@direct.musc.edu

Organizations & group practices 4

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": "1178582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292976000000",
    "number": "1801009782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 918025",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328918025",
            "telephone_number": "352-334-1390",
            "fax_number": "352-334-1325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326103003",
            "telephone_number": "352-334-1390",
            "fax_number": "352-334-1325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUDGE",
        "first_name": "ELIZABETH",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-08",
        "last_updated": "2010-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "NC",
            "license": "2005-01246",
            "primary": false
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "FL",
            "license": "ME108315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002840300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.