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  7. NPI Record 1659572816

BAPTIST PHYSICIAN GROUP LLC
Complete NPI Record 1659572816
Orthopaedic Surgery - Sports Medicine in Gulf Breeze, FL

NPI Status: Active since May 29, 2007

Contact Information

1040 GULF BREEZE PKWY
SUITE 200
GULF BREEZE, FL
ZIP 32561
Phone: (850) 916-3700
Fax: (850) 916-3710

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Second Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Business Practice Location Address Fax Number
  20. Provider Enumeration Date
  21. Last Update Date
  22. Authorized Official Last Name
  23. Authorized Official First Name
  24. Authorized Official Middle Name
  25. Authorized Official Title or Position
  26. Authorized Official Telephone Number
  27. Healthcare Provider Taxonomy Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Healthcare Provider Taxonomy Code 2
  30. Healthcare Provider Primary Taxonomy Switch 2
  31. Healthcare Provider Taxonomy Code 3
  32. Healthcare Provider Primary Taxonomy Switch 3
  33. Healthcare Provider Taxonomy Code 4
  34. Healthcare Provider Primary Taxonomy Switch 4
  35. Other Provider Identifier 1
  36. Other Provider Identifier Type Code 1
  37. Other Provider Identifier State 1
  38. Other Provider Identifier 2
  39. Other Provider Identifier Type Code 2
  40. Other Provider Identifier State 2
  41. Other Provider Identifier Issuer 2
  42. Other Provider Identifier 3
  43. Other Provider Identifier Type Code 3
  44. Other Provider Identifier State 3
  45. Is Organization Subpart
  46. Authorized Official Name Prefix Text
  47. Healthcare Provider Taxonomy Group 1
  48. Healthcare Provider Taxonomy Group 2
  49. Healthcare Provider Taxonomy Group 3
  50. Healthcare Provider Taxonomy Group 4

Complete NPI Dataset

This page represents the complete record for NPI 1659572816. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1659572816
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: PO BOX 30532
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: PENSACOLA
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Provider Business Mailing Address State Name: FL
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Business Mailing Address Postal Code: 325031532
The last name of the provider. If the provider is an individual, this is the legal name.
Provider Business Mailing Address Country Code If outside U S : US
The first name of the provider, if the provider is an individual.
Provider Business Mailing Address Telephone Number: 8509163700
The middle name of the provider, if the provider is an individual.
Provider Business Mailing Address Fax Number: 8509163710
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider First Line Business Practice Location Address: 1040 GULF BREEZE PKWY
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider Second Line Business Practice Location Address: SUITE 200
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Practice Location Address City Name: GULF BREEZE
The city name in the mailing address of the provider being identified.
Provider Business Practice Location Address State Name: FL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Practice Location Address Postal Code: 325617809
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Practice Location Address Telephone Number: 8509163700
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 8509163710
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/29/2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 7/21/2022
The date that a record was last updated or changed.
Authorized Official Last Name: RAYNES
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: BRYON
The first name of the authorized official.
Authorized Official Middle Name: SCOTT
The middle name of the authorized official.
Authorized Official Title or Position: PRESIDENT
The title or position of the authorized official.
Authorized Official Telephone Number: 8504692319
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 207QS0010X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 2081S0010X
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 363A00000X
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 207XX0005X
Healthcare Provider Primary Taxonomy Switch 4: Y
Other Provider Identifier 1: 110608
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: AL
Other Provider Identifier 2: 39662
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: FL
Other Provider Identifier Issuer 2: BLUE CROSS BLUE SHIELD
Other Provider Identifier 3: 001330100
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: FL
Is Organization Subpart: N
Authorized Official Name Prefix Text: MR.
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP