NPIMap

Individual provider Active NPI

Mark Samuel Eichenbaum, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • St Petersburg, FL
National Provider Identifier
1871764977
Registry record updated Feb 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
ME 100677 Issued in FL
Practice address
4320 Central Ave
Saint Petersburg, FL 33711-1141
Phone
(727) 345-3621
Fax
(727) 381-4934
NPI assigned
Mar 17, 2008
Last updated
Feb 29, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 29, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X ME 100677 FL Primary

Addresses

Primary practice location

4320 Central Ave
Saint Petersburg, FL 33711-1141

Mailing address

4320 Central Ave
Saint Petersburg, FL 33711-1141
Phone (727) 345-3621

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090622000314 FL Practitioner - Internal MedicinePractitioner - Geriatric Medicine 8426105685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
New York University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

4320 Central Ave
St Petersburg, FL 33711-1141
Phone (727) 345-3621

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
38.56 of 100Reported as individual
Quality
46.67
Improvement activities
0
Cost
66.32

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions164

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 100677FLMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Harry W Eichenbaum MD PA Geriatric Medicine CurrentSince Jun 20, 2009 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1609 Pasadena Ave S
Ste 3G
South Pasadena, FL 33707
Phone (727) 345-3621

4320 Central Ave
St Petersburg, FL 33711
Phone (727) 345-3621

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330473600000",
    "number": "1871764977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4320 CENTRAL AVE",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337111141",
            "telephone_number": "727-345-3621",
            "fax_number": "727-381-4934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 CENTRAL AVE",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337111141",
            "telephone_number": "727-345-3621",
            "fax_number": "727-381-4934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EICHENBAUM",
        "first_name": "MARK",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-17",
        "last_updated": "2012-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME 100677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.