Jerry W Bishop, M.D.
Individual provider Active NPI Family Medicine Physician · Dade City, FL
NPI 1982607875 · NPPES record last updated Feb 10, 2020
Key facts
- NPI
- 1982607875
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- ME92732 (FL)
- Practice address
- 13933 17TH St Ste 101
Dade City, FL 33525-4604 - Phone
- (352) 567-6763
- Fax
- (352) 567-2146
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050818000271 | FL | Practitioner - Family Practice | 2961390760 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME92732 | FL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florida Hospital Physician Group Inc | Family Medicine | Current |
Accepting new patients |
| Adventhealth Primary Care Network Inc | Family Medicine | Current |
Accepting new patients |
| St Anthony'S Primary Care LLC | Family Medicine | Past | Accepting new patients |
| Healthpoint Medical Group Inc | Family Medicine | Past | Accepting new patients |
Locations
661 E Altamonte Dr
Ste 115
Altamonte Springs, FL 32701
Phone (407) 831-4040
13933 17th St
Ste 101
Dade City, FL 33525
Phone (352) 567-6763
900 Hope Way
Forest City, FL 32714
Phone (407) 357-1255
13901 Bruce B Downs Blvd
Tampa, FL 33613
Phone (813) 615-7260
2700 Healing Way
Ste 310
Wesley Chapel, FL 33543
Phone (813) 779-1209
Interoperability endpoints
- jbishop73656@adventhealth.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ME92732 | FL | Yes |
Addresses
Primary practice location
13933 17TH St Ste 101
Dade City, FL 33525-4604
Mailing address
13933 17TH St Ste 101
Dade City, FL 33525-4604
Phone (352) 567-6763
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 272805200 | Medicaid | FL | |
| P00652865 | Other | FL | RAILROAD MEDICARE PROVIDER NUMBER |
Other providers in Dade City, FL
- Thomas Berardi
- Nicole A Berti-Mansour
- Carla A Bevins
- Biomedex LLC
- Biomedex LLC
- Meghan Bisson
- Jeannine Blackwell
- Coral Lynn Blake
- Daddy Nimoh Boateng
- Robert H. Booker
All providers in Dade City, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.