Lifestyle Performance Medicine

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD34871 Issued in AL

Legal business name

LIFESTYLE PERFORMANCE MEDICINE

Practice address

24847 Commercial Ave
Orange Beach, AL 36561-3845

Phone

(251) 979-2067

NPI assigned

Jul 21, 2016

Organization subpart

No

Name

Susan Vega

Title

Office Contact

Phone

(850) 889-0711

Organizations that report the same tax identification number in the National Provider Directory.

• Regenesis LLC

  • Medical Physician Assistant
  • Pace, FL
  • NPI 1366831554
  NPD tax ID

Tax ID family

Lifestyle Performance Medicine (2 organizations share this tax ID)

Locations

• Regenesis LLC Other name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 25, 2016.

{
    "created_epoch": "1469059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469404800000",
    "number": "1922451376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6506 N DAVIS HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325046957",
            "telephone_number": "850-889-0711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24847 COMMERCIAL AVE",
            "city": "ORANGE BEACH",
            "state": "AL",
            "postal_code": "365613845",
            "telephone_number": "251-979-2067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTYLE PERFORMANCE MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-21",
        "last_updated": "2016-07-25",
        "status": "A",
        "authorized_official_last_name": "VEGA",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OFFICE CONTACT",
        "authorized_official_telephone_number": "850-889-0711"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AL",
            "license": "MD34871",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE-FLORIDA",
            "identifier": "PA9108469",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE-ALABAMA",
            "identifier": "MD34871",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE-ALABAMA",
            "identifier": "PA1108",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE-FLORIDA",
            "identifier": "ME83357",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regenesis LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• James Robert Kimball, M.D.
• Katey Lynn Kimbro, LPTA
• Randall Brian Knutson, MD
• Melissa R Lacour, PT
• Jeanette Hinchey Lark, MPT
• Jeffrey Allen Lipke, M.D.
• Look Baldwin LLC
• Look Baldwin Vision LLC
• Elizabeth Sloan Lovett, CRNP
• Caroline Luck, MSW

• All providers in Orange Beach, AL
• Specialist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; 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.