MR. MICHAEL P EDERER (NPI# 1588760268) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588760268 |
| Entity Type | Individual |
| Full Name | MR. MICHAEL P EDERER |
| Credential | DO |
| Practice Address |
1001 College Blvd W Ste H Niceville FL 32578-1049 |
| Mailing Address |
1001 College Blvd Ste H Niceville FL 32578-1049 |
| Practice Telephone | 8502794417 |
| Practice Fax Number | 8502794212 |
| Mailing Telephone | 8502794417 |
| Mailing Fax Number | 8502794212 |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2017-07-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
PM 126, DO 136 | AL | Allopathic & Osteopathic Physicians |
| N | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
OS9533 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 273858900 | 05 | |
| AL | RAILROAD MEDICARE | PO1328054 | 01 |
| AL | BLUE CROSS | 511-23910 | 01 |
| AL | BC | 511-61498 | 01 |
| FL | BLUE CROSS BLUE SHIELD | 16148 | 01 |
| FL | RAILROAD MEDICARE | P00271270 | 01 |
| Street Address |
1001 COLLEGE BLVD W STE H |
| City | NICEVILLE |
| State | FL |
| Zip Code | 32578-1049 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932205606 | Coastal Anesthesia, P A | Anesthesiology | 1001 College Blvd W Ste H, Niceville, FL 32578-1049 | 2006-09-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376028563 | Southern Breeze Healthcare | Family Medicine | 4556 E Hwy 20, Suite 105, Niceville, FL 32578 | 2018-10-03 |
| 1497252860 | Molly Marie Everitt | Physician Assistant | 2190 Fl-85 N, Niceville, FL 32578 | 2018-04-11 |
| 1972009314 | Alexis Aust | Student in an Organized Health Care Education/Training Program | 104 Arrowhead Way, Niceville, FL 32578 | 2018-04-04 |
| 1518488949 | Michelle Sasala | Nurse Practitioner | 4550 E Highway 20, Niceville, FL 32578 | 2017-07-06 |
| 1003336199 | Comfortable Care Denta Health Professionals, Pa | Dentist | 1386 E John Sims Parkway, Niceville, FL 32578 | 2017-06-21 |
| 1306223888 | Emerald Coast Periodontics | Dentist | 719 Bayshore Drive, Niceville, FL 32578 | 2015-05-04 |
| 1538586136 | Pamela Ottesen Dmd LLC | Dentist | 1536 John Sims Pkwy, Niceville, FL 32578 | 2014-03-21 |
| 1417204066 | Mary Jo Stiles | Hearing Instrument Specialist | 4400 Hwy, 20 East, Suite # 211, Niceville, FL 32578 | 2012-08-13 |
| 1093086563 | Pat T. Tidwell Md Pa | Clinic/Center | 4554 Highway 20 East, Niceville, FL 32578 | 2012-01-16 |
| 1952683260 | Gentle Birth Options, LLC | Nurse Practitioner | 296 Bayshore Drive, Niceville, FL 32578 | 2011-09-13 |
| Find all providers in zip 32578 | ||||
| Taxonomy Code | 207LP2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Pain Medicine |
| An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659477461 | Bayshore Anesthesia P A | Anesthesiology | 2190 Highway 85 N, Niceville, FL 32578-1045 | 2006-09-16 |
| 1922104678 | Arthur Paul Broaderick | Anesthesiology | 2190 Highway 85 N, Niceville, FL 32578-1045 | 2006-09-16 |
| 1932205606 | Coastal Anesthesia, P A | Anesthesiology | 1001 College Blvd W Ste H, Niceville, FL 32578-1049 | 2006-09-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578181087 | John Peter Lafferty Iv | Anesthesiology | 2039 Hillview St Apt 4, Sarasota, FL 34239-2396 | 2020-07-10 |
| 1679197735 | Dynamic Pain & Wellness Pllc | Anesthesiology | 325 John Knox Rd Bldg 200, Tallahassee, FL 32303-4114 | 2020-06-04 |
| 1689294621 | Advanced Pain Management and Wellness Center | Anesthesiology | 241 Porgee Rock Pl, Jupiter, FL 33458-1635 | 2020-04-20 |
| 1548800808 | Ortho Florida, LLC | Anesthesiology | 11135 S Jog Road Ste 5, Boynton Beach, FL 33437 | 2020-01-14 |
| 1346886033 | Spine and Orthopedic Specialists of Tampa, LLC | Anesthesiology | 6919 N Dale Mabry Hwy Ste 325, Tampa, FL 33614-3860 | 2019-11-18 |
| 1700446077 | Gulf Coast Pain Consultants LLC | Anesthesiology | 182 A East Redstone Ave, Crestview, FL 32539-5371 | 2019-06-18 |
| 1265099386 | Gulf Coast Pain Consultants LLC | Anesthesiology | 10437 Sorrento Rd Ste 203, Pensacola, FL 32507-7620 | 2019-05-23 |
| 1023673951 | Apollo Pain Management | Anesthesiology | 720 Cortaro Drive, Sun City Center, FL 33573 | 2019-05-06 |
| 1861056384 | Englewood Pain Management LLC | Anesthesiology | 2061 Englewood Rd Ste 2a, Englewood, FL 34223-1747 | 2019-04-30 |
| 1962066241 | Doctors Best Wellness Centers Inc | Anesthesiology | 2237 N Commerce Pkwy Ste 3, Weston, FL 33326-3250 | 2019-04-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.