Douglas Ebersole, MD

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

ME51795 Issued in FL

Practice address

1600 Lakeland Hills Blvd
Lakeland, FL 33805

Phone

(863) 680-7490

Fax

(866) 264-8519

NPI assigned

Feb 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Interventional CardiologyAlso: Cardiovascular Disease (Cardiology), Internal Medicine

Education

University of Miami, LM Miller School of Medicine, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Watson Clinic LLPGroup PAC ID 1456258979, 365 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lakeland Regional Medical Center Hospital, Lakeland, FL, CCN 100157

Merit-based Incentive Payment System (MIPS)

Final score

87.18 of 100Reported as apm

Quality

70.68

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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

• Watson Clinic LLP

  • Internal Medicine Physician
  • Lakeland, FL
  • NPI 1316940695

  Interventional Cardiology

  Medicare reassignment Care Compare group NPD
• Watson Clinic LLP

  • Clinical Medical Laboratory
  • Lakeland, FL
  • NPI 1558409730
  NPD (past)

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

• Lakeland Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Lakeland, FL
  • NPI 1144228446
  Care Compare affiliation

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1972575736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 LAKELAND HILLS BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053019",
            "telephone_number": "863-680-7000",
            "fax_number": "866-264-8519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 LAKELAND HILLS BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "33805",
            "telephone_number": "863-680-7490",
            "fax_number": "866-264-8519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERSOLE",
        "first_name": "DOUGLAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "FL",
            "license": "ME51795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "debersole6603@direct.watsonclinicad.com",
            "affiliation": "Y",
            "endpointDescription": "Direct Message Address",
            "affiliationName": "Watson Clinic LLP",
            "address_1": "1430 Lakeland Hills Blvd",
            "city": "Lakeland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "338053202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robert Eanett, MD
• Dannie Earl, MD
• Claudia Earle
• Amy Melissa Eaton, APRN
• Carol Johnson Ebersole, MD
• Eric Ebuen, DMD
• Esther Echevarria, M.D.
• Javier Enrique Echevarria, DMD
• Alison Eckert, MSW
• Amber Edelmann, ARNP

• Interventional Cardiology Physician in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Interventional Cardiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.