NPIMap

Individual provider Active NPI

Shane Christopher Hernesman, MD

  • Family Medicine Physician
  • Merritt Island, FL
National Provider Identifier
1952412652
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME83457 Issued in FL
Practice address
650 S Courtenay Pkwy
Suite 100
Merritt Island, FL 32952-4977
Phone
(321) 453-5888
NPI assigned
Aug 31, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME83457 FL Primary

Addresses

Primary practice location

650 S Courtenay Pkwy
Suite 100
Merritt Island, FL 32952-4977

Mailing address

650 S Courtenay Pkwy
Suite 100
Merritt Island, FL 32952-4977
Phone (321) 453-5888

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
I20070507000212 FL Practitioner - Family Practice 0749386811 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians
Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians

Practice addresses (Care Compare)

1200 Lexington Green LN
Sanford, FL 32771-1013

1980 N Atlantic Ave
Cocoa Beach, FL 32931-3274
Phone (321) 453-5888

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME83457FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shane C Hernesman MD PA Family Medicine CurrentSince Oct 2, 2006 Accepting new patients

Locations

505 Delannoy Ave
Cocoa, FL 32922
Phone (321) 631-4940

1980 N Atlantic Ave
Ste 630
Cocoa Beach, FL 32931
Phone (321) 453-5888

Interoperability endpoints

  • Direct secure messaging: shane.hernesman.1@17163.direct.athenahealth.com

Organizations & group practices 1

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 10

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

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952412652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 S COURTENAY PKWY",
            "address_2": "SUITE 100",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329524977",
            "telephone_number": "321-453-5888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 S COURTENAY PKWY",
            "address_2": "SUITE 100",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329524977",
            "telephone_number": "321-453-5888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNESMAN",
        "first_name": "SHANE",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME83457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

Verify at the official NPI Registry.