NPIMap

Organization Active NPI

Southland EMS at Madison, PLLC

  • Emergency Medicine Physician
  • Madison, FL
National Provider Identifier
1801024880
Registry record updated Sep 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
SOUTHLAND EMS AT MADISON, PLLC
Practice address
224 NW Crane Ave
Madison, FL 32340-1400
Phone
(850) 973-2271
NPI assigned
Jun 29, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2022

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

Authorized official

Name
Paul Hart, M.D.NPI 1629021415
Title
Director
Phone
(205) 907-2586

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

224 NW Crane Ave
Madison, FL 32340-1400

Mailing address

PO Box 5218
Niceville, FL 32578-5218
Phone (850) 897-7244

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091005000551 FL Part B Supplier - Clinic/Group Practice 1456497437 Receives reassigned benefits from 17 practitioners
Practice locations: Madison, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662508800000",
    "number": "1801024880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5218",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325785218",
            "telephone_number": "850-897-7244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 NW CRANE AVE",
            "city": "MADISON",
            "state": "FL",
            "postal_code": "323401400",
            "telephone_number": "850-973-2271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND EMS AT MADISON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-29",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A",
        "authorized_official_last_name": "HART",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "205-907-2586",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.