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WHITE-WILSON MEDICAL CENTER PA
NPI 1467437277
Clinic/Center in Fort Walton Beach, FL

Active since December 14, 2005CLIA 10D2117251 · Waiver
1005 MAR WALT DR, ADMINISTRATION, FORT WALTON BEACH, FL 32547(850) 863-8131(850) 863-4152 Get Directions Write a Review

NPPES record last updated: May 15, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: May 15, 2026, Nov 15, 2019 (2 updates tracked since 2019).

About White-wilson Medical Center Pa NPPES

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

WHITE-WILSON MEDICAL CENTER PA (NPI 1467437277), doing business as White-wilson Medical Center, is a healthcare organization registered as a clinic/center in Fort Walton Beach, Florida and active in the NPI registry since December 2005. The organization holds a CLIA Waiver certificate valid through August 11, 2028, maintains 11 additional practice locations, and lists Kathy A Leeper, Medical Staff Coordinator, as its authorized official.

NPPES Registry Identity

NPI1467437277
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameWHITE-WILSON MEDICAL CENTER PA
Location Address1005 MAR WALT DR, ADMINISTRATIONFort Walton Beach, FL 32547-6707
Mailing Address1005 Mar Walt Dr, AdministrationFort Walton Beach, FL 32547-6707 · (850) 863-8131 · Fax (850) 863-4152
Phone(850) 863-8131
Fax(850) 863-4152
Organization SubpartNo
Authorized OfficialKathy A LeeperMedical Staff Coordinator · (850) 863-8150
Enumeration DateDecember 14, 2005
Last NPPES UpdateMay 15, 20262 updates tracked since enumeration
NPPES CertifiedMay 15, 2026
✔ NPI 1467437277 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
1005 MAR WALT DR, Fort Walton Beach, FL 32547
Open in Google Maps ↗

Other Names 1

Doing Business AsWhite-wilson Medical Center

Secondary Practice Locations 11

Location 11332 N Ferdon BlvdCrestview, FL 32536-1749 · Phone (850) 634-6193 · Fax (833) 741-3080
Location 22001 E Highway 20Niceville, FL 32578-8826 · Phone (850) 897-4400 · Fax (850) 897-0623
Location 3127 E Redstone AveCrestview, FL 32539-5358 · Phone (850) 398-8725 · Fax (833) 305-0362
Location 41032 Mar Walt Dr Unit 210Fort Walton Beach, FL 32547-6661 · Phone (850) 863-8260 · Fax (833) 916-2248
Location 5990 Airport RdDestin, FL 32541-2820 · Phone (850) 269-6400 · Fax (850) 654-9581
Location 6130 E Redstone AveCrestview, FL 32539-5348 · Phone (850) 398-8725 · Fax (833) 305-0361
Location 71110 Hospital RdFort Walton Beach, FL 32547-6742 · Phone (850) 863-8100 · Fax (850) 863-8548
Location 88990 Navarre PkwyNavarre, FL 32566-2216 · Phone (850) 396-0108 · Fax (850) 939-4933
Location 9999 Mar Walt DrFort Walton Beach, FL 32547-6758 · Phone (850) 863-8269 · Fax (833) 916-2269
Location 101106 Hospital RdFort Walton Beach, FL 32547-6742 · Phone (850) 863-8169 · Fax (833) 916-2251
Location 111045 Hwy 331 South, Suite DDeFuniak Springs, FL 32435-3379 · Phone (850) 892-3366 · Fax (833) 451-2226

Other Identifiers 1

Medicaid130182500FL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Superior HealthPlan, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

White-wilson Medical Center Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

57

Medicare enrollment records show 57 clinicians reassign Medicare billing to White-Wilson Medical Center PA, which bills Medicare for the services they deliver. Of these, 20 practice at this address and 25 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 10

Nurse Practitioner23
Family Practice8
Diagnostic Radiology7
Pediatric Medicine7
Internal Medicine4
General Surgery3
General Practice2
Cardiovascular Disease (Cardiology)1
2 other specialties2

Nearest to this location (20)

See all 57
Aaliyah Denton
Nurse Practitioner
NPI 1689520660
1005 MAR WALT DR
Fort Walton Beach, FL 32547
(850) 863-8100
✔ PECOS✔ Accepts MedicareSame address
Margaret Avery, FNP-BC
Nurse Practitioner
NPI 1306422191
1005 MAR WALT DR
Fort Walton Beach, FL 32547
(850) 863-8202
✔ PECOS✔ Accepts MedicareSame address
Katrina Borner, ARNP
Nurse Practitioner
NPI 1467988220
1005 MAR WALT DR
Fort Walton Beach, FL 32547
(850) 863-6600
✔ PECOS✔ Accepts MedicareSame address
Brianne Freel
Nurse Practitioner
NPI 1134630197
1005 MAR WALT DR
Fort Walton Beach, FL 32547
(850) 863-6600
✔ PECOS✔ Accepts MedicareSame address
Kimberly Marshall, NP
Nurse Practitioner
NPI 1538923297
1005 MAR WALT DR
Fort Walton Beach, FL 32547
(850) 863-8202
✔ PECOS✔ Accepts MedicareSame address
Terry Payne, M.D.
Family Practice
NPI 1053396002
1005 MAR WALT DR
Fort Walton Beach, FL 32547
(850) 863-6600
✔ PECOS✔ Accepts MedicareSame address
Rebecca Kinsley
Nurse Practitioner
NPI 1457294548
1005 MAR WALT DR
Fort Walton Beach, FL 32547
(850) 863-8203
✔ PECOSSame address
Karl Metz, M.D.
General Practice
NPI 1134104169
1005 MAR WALT DR LABORATORY
Fort Walton Beach, FL 32547
(850) 863-8109
✔ PECOS✔ Accepts MedicareSame address
Jennifer Reid, FNP
Nurse Practitioner
NPI 1497616999
1005 MAR WALT DR
Fort Walton Beach, FL 32547
(850) 863-8100
✔ PECOS✔ Accepts MedicareSame address
Mariana Ruiz
Nurse Practitioner
NPI 1750238929
1005 MAR WALT DR
Fort Walton Beach, FL 32547
(850) 863-6600
✔ PECOSSame address
Melissa Fischer, M.D.
Internal Medicine
NPI 1942285036
1005 MAR WALT DRIVE INTERNAL MEDICINE DEPARTMENT
Fort Walton Beach, FL 32547
(850) 863-8202
✔ PECOS✔ Accepts MedicareSame address
Robert Shelton, M.D.
Pediatric Medicine
NPI 1871578781
1005 MAR WALT DRIVE PEDIATRIC DEPARTMENT
Fort Walton Beach, FL 32547
(850) 863-8203
✔ PECOSSame address
Timothy Skinner, AU.D.
Qualified Audiologist
NPI 1043433022
1005 MAR WALT DRIVE AUDIOLOGY DEPARTMENT
Fort Walton Beach, FL 32547
(850) 863-8232
✔ Accepts MedicareSame address
Chinh Van, M.D.
Family Practice
NPI 1124336839
1005 MAR WALT DRIVE IMMEDIATE CARE DEPARTMENT
Fort Walton Beach, FL 32547
(850) 863-8219
✔ PECOS✔ Accepts MedicareSame address
Vergil Brown, M.D.
Internal Medicine
NPI 1871578955
1005 MAR WALT DR INTERNAL MEDICINE
Fort Walton Beach, FL 32547
(850) 863-8209
✔ PECOS✔ Accepts MedicareSame address
Christopher Hansen, M.D.
Family Practice
NPI 1306821293
1005 MAR WALT DR FAMILY PRACTICE DEPARTMENT
Fort Walton Beach, FL 32547
(850) 863-6600
✔ PECOS✔ Accepts MedicareSame address
John Mills, M.D.
Family Practice
NPI 1437134301
1005 MAR WALT DR IMMEDIATE CARE DEPARTMENT
Fort Walton Beach, FL 32547
(850) 863-8219
✔ PECOS✔ Accepts MedicareSame address
Rodney Powell, MD
Cardiovascular Disease (Cardiology)
NPI 1821063959
1005 MAR WALT DR CARDIOLOGY DEPARTMENT
Ft Walton Beach, FL 32547
(850) 862-6934
✔ PECOS✔ Accepts MedicareSame address
David Erickson, MD
Pediatric Medicine
NPI 1942390232
1005 MAR WALT DR
Fort Walton Beach, FL 32547
(850) 863-8203
✔ PECOSSame address
Philip Jessen, APRN
Nurse Practitioner
NPI 1871977173
1005 MAR WALT DRIVE INTERNAL MEDICINE DEPARTMENT
Fort Walton Beach, FL 32547
(850) 863-8202
✔ PECOS✔ Accepts MedicareSame address
See all 57 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2117251

White-Wilson Medical Center · Navarre, FL
Active · expires Aug 11, 2028
CLIA Number10D2117251
Laboratory TypePhysician Office
Certificate Effective DateAugust 12, 2026
Certificate Expiration DateAugust 11, 2028
Laboratory DirectorChinh V. Van
Laboratory Phone(850) 868-8277
Laboratory LocationWhite-Wilson Medical Center8990 Navarre Pkwy, Navarre, FL 32566
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

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 White-Wilson Medical Center PA's NPI number?

The NPI number for White-Wilson Medical Center PA is 1467437277. It was assigned to this organization in the NPPES registry on December 14, 2005. The provider is doing business as White-Wilson Medical Center.

Where is White-Wilson Medical Center PA located?

White-Wilson Medical Center PA is located at 1005 Mar Walt Dr Administration, Fort Walton Beach, FL 32547. The listed phone number is (850) 863-8131.

What is White-Wilson Medical Center PA's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Is White-Wilson Medical Center PA enrolled in Medicare?

Yes. White-Wilson Medical Center PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through White-Wilson Medical Center PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 57 clinicians in 10 Medicare specialties reassign their Medicare billing to White-Wilson Medical Center PA. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (23), Family Practice (8) and Diagnostic Radiology (7). Of these, 20 practice at this address and 25 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does White-Wilson Medical Center PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2117251) is associated with this NPI, valid through August 11, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does White-Wilson Medical Center PA accept?

Health plans from Ambetter Health, Ambetter from Superior HealthPlan, Ambetter of Alabama, Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list White-Wilson Medical Center PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for White-Wilson Medical Center PA was last updated on May 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.