Active NPI
Martin Engwall Sheline, MD
- Diagnostic Radiology Physician
- Panama City, FL
National Provider Identifier
1982638466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- ME109093
- Practice address
- 527 N. Palo Alto Ave
Panama City, FL 32401-3639 - Phone
- (850) 747-4905
- Fax
- (850) 747-4907
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular & Interventional Radiology Physician | 2085R0204X | 34710 | GA | |
| Diagnostic Radiology Physician | 2085R0202X | ME109093 | FL | Primary |
| Vascular & Interventional Radiology Physician | 2085R0204X | ME109093 | FL |
Addresses
Primary practice location
527 N. Palo Alto Ave
Panama City, FL 32401-3639
Mailing address
P.O. Box 1770
Panama City, FL 32402-1770
Phone (850) 747-4905
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003672200 | Medicaid | FL | |
| 14E53 | Other | FL | BCBS |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME109093 | FL | MD | Vascular & Interventional Radiology Physician |
| 34710 | GA | MD | Vascular & Interventional Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317859200000",
"number": "1982638466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 1770",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324021770",
"telephone_number": "850-747-4905",
"fax_number": "850-747-4907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "527 N. PALO ALTO AVE",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324013639",
"telephone_number": "850-747-4905",
"fax_number": "850-747-4907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELINE",
"first_name": "MARTIN",
"middle_name": "ENGWALL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2011-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "GA",
"license": "34710",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "FL",
"license": "ME109093",
"primary": true
},
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "FL",
"license": "ME109093",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003672200",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "14E53",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Panama City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.