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DR. MARJORIE DINA BACON MD
NPI 1174145304
Family Medicine in St Augustine, FL

Active since May 11, 2020Opted out of Medicare · through Jul 9, 2027
442 PASEO REYES DR, ST AUGUSTINE, FL 32095(904) 544-1738(904) 872-8863 Get Directions Write a Review

NPPES record last updated: July 16, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Marjorie Dina Bacon Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MARJORIE DINA BACON MD (NPI 1174145304) is an individual family medicine provider in St Augustine, Florida, licensed in Florida (ME158234) and active in the NPI registry since May 2020. She has opted out of Medicare through July 9, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1174145304
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameDR. MARJORIE DINA BACONCredential: MD
Location Address442 PASEO REYES DRSt Augustine, FL 32095-8558
Mailing Address442 Paseo Reyes DrSt Augustine, FL 32095-8558 · (904) 544-1738 · Fax (904) 872-8863
Phone(904) 544-1738
Fax(904) 872-8863
Sole ProprietorYes
Enumeration DateMay 11, 2020
Last NPPES UpdateJuly 16, 2025
NPPES CertifiedJuly 16, 2025
✔ NPI 1174145304 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Licenses✔ Licensed in FL · ME158234✔ Licensed in LA · 338808✔ Licensed in AZ · 1908R77909
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
442 PASEO REYES DR, St Augustine, FL 32095
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Dr. Marjorie Dina Bacon Md has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 9, 2023 through July 9, 2027.

Opt-Out Effective DateJuly 9, 2023
Opt-Out In Effect ThroughJuly 9, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32095 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$87.62 typical visit price
range $56.00 – $171.84
Typical copayment $21.90 (range $14.00 – $42.96)
Most-billed visit code 99203
Established Patient
$99.16 typical visit price
range $17.57 – $139.16
Typical copayment $24.79 (range $4.39 – $34.79)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Lightweight wheelchair K0003
DME-Wheelchairs · category DD000N
1 supplier12 claims12 services$26.50 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Marjorie Bacon's NPI number?

The NPI number for Marjorie Bacon is 1174145304. It was assigned to this individual provider in the NPPES registry on May 11, 2020.

Where is Marjorie Bacon located?

Marjorie Bacon practices at 442 Paseo Reyes Dr, St Augustine, FL 32095. The listed phone number is (904) 544-1738.

What is Marjorie Bacon's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Marjorie Bacon enrolled in Medicare?

No. Marjorie Bacon has opted out of Medicare through July 9, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Marjorie Bacon was last updated on July 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.