Individual provider Active NPI

Vincent G Verdeflor, M.D.

  • Pediatrics Physician
  • Palm Coast, FL
National Provider Identifier
1972785327
Registry record updated Aug 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME97678 Issued in FL
Practice address
180 Pinnacles Dr
Suite 100
Palm Coast, FL 32164-2596
Phone
(386) 313-1963
Fax
(386) 313-1962
NPI assigned
Nov 28, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME97678 FL Primary

Addresses

Primary practice location

180 Pinnacles Dr
Suite 100
Palm Coast, FL 32164-2596

Mailing address

180 Pinnacles Dr
Suite 100
Palm Coast, FL 32164-2596
Phone (386) 313-1963

Other identifiers 1

IdentifierTypeStateIssuer
280112400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME97678FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacles Peds Care, PA Pediatrics Past Accepting new patients
Pediatrica Health of Florida, LLC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503273600000",
    "number": "1972785327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 PINNACLES DR",
            "address_2": "SUITE 100",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321642596",
            "telephone_number": "386-313-1963",
            "fax_number": "386-313-1962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 PINNACLES DR",
            "address_2": "SUITE 100",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321642596",
            "telephone_number": "386-313-1963",
            "fax_number": "386-313-1962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERDEFLOR",
        "first_name": "VINCENT",
        "middle_name": "G",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-28",
        "last_updated": "2017-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME97678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "280112400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Coast, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2017; 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.