Southeastern Integrated Medical PL

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

Legal business name

SOUTHEASTERN INTEGRATED MEDICAL PL

Practice address

4343 W Newberry Rd
Gainesville, FL 32607-2817

Phone

(352) 224-2200

Fax

(352) 224-2484

NPI assigned

Jan 17, 2006

Last updated

Mar 9, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

SOUTHEASTERN INTEGRATED MEDICAL PLAs reported in NPPES

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

Authorized official

Name

Daniel M Duncanson, M.D.,C.P.E.NPI 1477535524

Title

Cheif Executive Officer

Phone

(352) 224-2200

Specialties & licenses 15

Addresses

Other identifiers 1

Part of

Southeastern Integrated Medical PL

Locations

Practitioners 12

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.

• Daniel M. Duncanson, MD

  • Internal Medicine Physician
  • Gainesville, FL
  • NPI 1477535524
  Authorized official Same address or phone
• Ashley Thomas

  • Neurology Physician
  • Birmingham, AL
  • NPI 1275794539
  NPD
• Salah Antar, MD

  • Clinical Pathology/Laboratory Medicine Physician
  • Tampa, FL
  • NPI 1487604930
  NPD (past)
• Melissa S. Blount, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Orlando, FL
  • NPI 1376594788
  NPD (past)
• Christina Cobty

  • Family Nurse Practitioner
  • Chiefland, FL
  • NPI 1801563606
  NPD (past)
• Beth W Dickey, ARNP

  • Family Nurse Practitioner
  • Chiefland, FL
  • NPI 1629250170
  NPD (past)
• John Derek Thompson, MD

  • Urology Physician
  • Ocala, FL
  • NPI 1578624342
  NPD (past)
• Lew Wajsman, MD

  • Specialist
  • Gainesville, FL
  • NPI 1174561112
  NPD (past)
• Brian A Bradley, MD

  • Urology Physician
  • San Angelo, TX
  • NPI 1356383269
  NPD (past)
• Valerie Jeanette Fields, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Greensboro, NC
  • NPI 1043399835
  NPD (past)
• William Patrick O'Neill, MD

  • Cytopathology Physician
  • Terre Haute, IN
  • NPI 1922118900
  NPD (past)
• Hitham Tayoun, M.D.

  • Cytopathology Physician
  • San Antonio, TX
  • NPI 1881643492
  NPD (past)

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1871573949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4881 NW 8TH AVE",
            "address_2": "SUITE 2",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054582",
            "telephone_number": "352-547-2373",
            "fax_number": "352-416-1813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 W NEWBERRY RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326072817",
            "telephone_number": "352-224-2200",
            "fax_number": "352-224-2484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN INTEGRATED MEDICAL PL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEASTERN INTEGRATED MEDICAL PL",
        "enumeration_date": "2006-01-17",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "DUNCANSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHEIF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "352-224-2200",
        "authorized_official_credential": "M.D.,C.P.E."
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207KA0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207KI0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology, Clinical & Laboratory Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RM1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nuclear Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058586600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Florida BBF Inc
• Keri Lynn Southall, ARNP
• Southeast Psychological Consulting, LLC
• Southeastern Counseling and Consultation LLC
• Southeastern Integrated Medical PL
• Southern Cardiac Interpretation PA
• Southland Medical Solutions of Al PL
• Kendra Southward, B.S.W
• Southwest Retirement Home, Inc.
• Frederick S Southwick, MD

• Neuromusculoskeletal Medicine & OMM Physician in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; 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.