NPIMap

Organization Active NPI

4MD2 in Patient Physician Services of Fort Walton Beach LLC

  • Hospitalist Physician
  • Fort Walton Beach, FL
National Provider Identifier
1821049867
Registry record updated Jul 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
4MD2 IN PATIENT PHYSICIAN SERVICES OF FORT WALTON BEACH LLC
Practice address
1000 Mar Walt Dr
Suite 266
Fort Walton Beach, FL 32547-6708
Phone
(850) 863-7607
Fax
(205) 437-5998
NPI assigned
May 15, 2006
Last updated
Jul 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2007

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

Authorized official

Name
Guy Duwane Hooper
Title
President
Phone
(205) 437-6098

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X Primary

Addresses

Primary practice location

1000 Mar Walt Dr
Suite 266
Fort Walton Beach, FL 32547-6708

Mailing address

PO Box 88477
Chicago, IL 60680-1477
Phone (205) 437-6098

Other identifiers 5

IdentifierTypeStateIssuer
2625352OtherFLUNITEDHEALTHCARE GROUP NO
97919OtherFLGROUP BCBS NUMBER
DE2953OtherFLGROUP RRMC NUMBER
7532779OtherFLAETNA GROUP NO
G017OtherALBCBS GROUP PROVIDER NO

National Provider Directory

National Provider Directory

Locations

1000 Mar Walt Dr
Ste 266
Ft Walton Bch, FL 32547
Phone (850) 863-7607

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184889600000",
    "number": "1821049867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88477",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606801477",
            "telephone_number": "205-437-6098",
            "fax_number": "205-437-5998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MAR WALT DR",
            "address_2": "SUITE 266",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476708",
            "telephone_number": "850-863-7607",
            "fax_number": "205-437-5998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4MD2 IN PATIENT PHYSICIAN SERVICES OF FORT WALTON BEACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "last_updated": "2007-07-20",
        "status": "A",
        "authorized_official_last_name": "HOOPER",
        "authorized_official_first_name": "GUY",
        "authorized_official_middle_name": "DUWANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-437-6098"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE GROUP NO",
            "identifier": "2625352",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BCBS NUMBER",
            "identifier": "97919",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP RRMC NUMBER",
            "identifier": "DE2953",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GROUP NO",
            "identifier": "7532779",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP PROVIDER NO",
            "identifier": "G017",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; 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.