Blue Heron Medical Group LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

D24872 Issued in MD

Legal business name

BLUE HERON MEDICAL GROUP LLC

Practice address

305 10TH St
Ste 101
Pocomoke City, MD 21851-1607

Phone

(410) 957-3005

Fax

(410) 957-0550

NPI assigned

Aug 28, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Paul Reardon Fleury, M.D.NPI 1265491286

Title

Doctor

Phone

(410) 957-3005

Specialties & licenses 6

Addresses

Other identifiers 6

Practitioners 1

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.

• Paul R Fleury, M.D.

  • Internal Medicine Physician
  • Pocomoke, MD
  • NPI 1265491286
  Authorized official Same address or phone

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

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330560000000",
    "number": "1861686313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 10TH ST",
            "address_2": "STE 101",
            "city": "POCOMOKE CITY",
            "state": "MD",
            "postal_code": "218511607",
            "telephone_number": "410-957-3005",
            "fax_number": "410-957-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 10TH ST",
            "address_2": "STE 101",
            "city": "POCOMOKE CITY",
            "state": "MD",
            "postal_code": "218511607",
            "telephone_number": "410-957-3005",
            "fax_number": "410-957-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE HERON MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-28",
        "last_updated": "2012-03-01",
        "status": "A",
        "authorized_official_last_name": "FLEURY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "REARDON",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "410-957-3005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D058928",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D45995",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D24872",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D24871",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D36576",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "Q37875",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1841384625",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1245292853",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1639269368",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1265491286",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1669558227",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1992764815",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Pocomoke City, MD
• Providers in Pocomoke City, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; 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.