BAPTIST PHYSICIAN GROUP LLC (NPI# 1659572816) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659572816 |
| Entity Type | Organization |
| Organization Name | BAPTIST PHYSICIAN GROUP LLC |
| Practice Address |
1040 Gulf Breeze Pkwy Suite 200 Gulf Breeze FL 32561-7809 |
| Mailing Address |
Po Box 30532 Pensacola FL 32503-1532 |
| Practice Telephone | 8509163700 |
| Practice Fax Number | 8509163710 |
| Mailing Telephone | (850) 916-3700 |
| Mailing Fax Number | 8509163710 |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2017-08-08 |
| Authorized Official Name | MR. BRYON SCOTT RAYNES (PRESIDENT) |
| Authorized Official Telephone | 8504692319 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2081S0010X |
Physical Medicine & Rehabilitation Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 001330100 | 05 | |
| FL | BLUE CROSS BLUE SHIELD | 39662 | 01 |
| AL | 110608 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730740218 | Baptist Physician Group LLC | Orthopaedic Surgery | 133 Racetrack Rd Nw, Fort Walton Beach, FL 32547-1644 | 2019-06-25 |
| 1609391929 | Baptist Physician Group LLC | Family Medicine | 8880 Navarre Pkwy Ste 206, Navarre, FL 32566-3614 | 2017-08-08 |
| 1609392018 | Baptist Physician Group LLC | Family Medicine | 9400 University Pkwy Ste 101a, Pensacola, FL 32514-5485 | 2017-08-17 |
| 1598280828 | Baptist Physician Group LLC | Family Medicine | 6715 W Highway 98, Pensacola, FL 32506-5923 | 2017-08-08 |
| 1427573757 | Baptist Physician Group LLC | Physical Medicine & Rehabilitation | 5100 N 12th Ave Ste 102, Pensacola, FL 32504-8919 | 2017-08-08 |
| 1720322811 | Baptist Physician Group LLC | Physician Assistant | 9400 University Pkwy, Suite 309, Pensacola, FL 32514-5752 | 2012-11-15 |
| Street Address |
1040 GULF BREEZE PKWY SUITE 200 |
| City | GULF BREEZE |
| State | FL |
| Zip Code | 32561-7809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972506723 | Steve E Jordan | Orthopaedic Surgery | 1040 Gulf Breeze Pkwy, Suite 200, Gulf Breeze, FL 32561-7809 | 2005-05-24 |
| 1184232696 | Mary Catherine Ray | Specialist/Technologist | 1040 Gulf Breeze Pkwy, Gulf Breeze, FL 32561-7809 | 2020-07-21 |
| 1740805902 | Ginger Christina Bogan | Specialist/Technologist | 1040 Gulf Breeze Pkwy, Gulf Breeze, FL 32561-7809 | 2020-06-13 |
| 1528682119 | Charles Alan Ray | Specialist/Technologist | 1040 Gulf Breeze Pkwy, Gulf Breeze, FL 32561-7809 | 2020-05-30 |
| 1730666850 | Amanda Nystrom | Specialist/Technologist | 1040 Gulf Breeze Pkwy, Gulf Breeze, FL 32561 | 2018-07-21 |
| 1043735285 | Matt Creamer | Physical Medicine & Rehabilitation | 1040 Gulf Breeze Pkwy, Gulf Breeze, FL 32561-7809 | 2017-08-09 |
| 1700323367 | Ortho Florida, LLC | Orthopaedic Surgery | 1040 Gulf Breeze Pkwy, Ste 209, Gulf Breeze, FL 32561-7809 | 2017-01-20 |
| 1639615180 | Ortho Florida, LLC | Orthopaedic Surgery | 1040 Gulf Breeze Pkwy, Ste 200, Gulf Breeze, FL 32561-7809 | 2017-01-09 |
| 1386095404 | Matthew Mcgraw | Specialist/Technologist | 1040 Gulf Breeze Pkwy, Suite 101, Gulf Breeze, FL 32561-7809 | 2016-06-30 |
| 1760845911 | Angela Marie Pectol | Specialist/Technologist | 1040 Gulf Breeze Pkwy, Gulf Breeze, FL 32561-7809 | 2016-04-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700416815 | Susan Carol Bane | Physical Therapist | 1500 Via Deluna, D6, Pensacola Beach, FL 32561 | 2020-01-17 |
| 1174027478 | Aegis Group Practice LLC | Occupational Therapist | 50 Joachim Drive, Gulf Breeze, FL 32561 | 2018-03-21 |
| 1497296081 | Gulf Coast Health System Imaging, LLC | Clinic/Center | 4033 Gulf Breeze Parkway, Gulf Breeze, FL 32561 | 2017-03-15 |
| 1265836233 | Karen Tarvid | Radiologic Technologist | 1390 Fort Pickens Road, 212, Gulf Breeze, FL 32561 | 2014-10-20 |
| 1063825990 | Thomas Ryan Mcpherson | Dentist | 41 Fairpoint Dr Ste A, Gulf Breeze, FL 32561 | 2014-06-09 |
| 1316210974 | White Edward Gibson IIi | Internal Medicine | 408 N. Sunset Blvd., Gulf Breeze, FL 32561 | 2012-02-13 |
| 1467742866 | Katherine Seipel Crawford | Pediatrics | 15 Daniel Dr, Gulf Breeze, FL 32561 | 2011-04-19 |
| 1497067987 | Total Spinal Solutions LLC | Clinic/Center | 1300 Shoreline Drive, Ste. 104, Gulf Breeze, FL 32561 | 2010-07-13 |
| 1528184322 | Bonnie Dansby | Nurse Practitioner | 1600 Via Deluna Drive, E403, Pensacola Beach, FL 32561 | 2007-03-22 |
| 1891841425 | Darby Lynn Godwin | Psychologist | 7 Center Road, Gulf Breeze, FL 32561 | 2007-01-26 |
| Find all providers in zip 32561 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174818785 | Tariq Khalid Hendawi | Orthopaedic Surgery | 1020 Gulf Breeze Pkwy, Gulf Breeze, FL 32561-4838 | 2011-06-10 |
| 1790932473 | Andrews Foundation for Research & Education, LLC | Orthopaedic Surgery | 1040 Gulf Breeze Pkwy, Suite 200, Gulf Breeze, FL 32561-7809 | 2008-08-25 |
| 1619027786 | Richard G Sellers Md Pa | Orthopaedic Surgery | 41 Fairpoint Dr Ste B, Gulf Breeze, FL 32561-4380 | 2007-01-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801401021 | Ortho Florida, LLC | Orthopaedic Surgery | 17425 7th St Ste 560174, Montverde, FL 34756-3206 | 2020-09-14 |
| 1801429022 | Ortho Florida, LLC | Orthopaedic Surgery | 2122 W Cypress Creek Rd Ste 202, Ft Lauderdale, FL 33309-1858 | 2020-02-17 |
| 1750913141 | Tyrance Orthopedics and Sports Medicine | Orthopaedic Surgery | 1620 S Congress Ave Ste 201, Palm Springs, FL 33461-2128 | 2020-02-04 |
| 1255979076 | Ortho Florida, LLC | Orthopaedic Surgery | 2122 W Cypress Crk Rd Ste 202, Fort Lauderdale, FL 33309-1858 | 2019-12-11 |
| 1730740218 | Baptist Physician Group LLC | Orthopaedic Surgery | 133 Racetrack Rd Nw, Fort Walton Beach, FL 32547-1644 | 2019-06-25 |
| 1164984720 | Ortho Florida, LLC | Orthopaedic Surgery | 21097 Ne 27th Ct Ste 590, Aventura, FL 33180-1246 | 2019-04-03 |
| 1578043998 | Bahri Orthopedics Institute | Orthopaedic Surgery | 6100 Kennerly Rd Ste 202, Jacksonville, FL 32216-4379 | 2018-08-15 |
| 1154834489 | Dorothy Richardson | Orthopaedic Surgery | 1120 W Lakeshore Dr, Clermont, FL 34711-2936 | 2017-11-08 |
| 1225541790 | Ortho Florida, LLC | Orthopaedic Surgery | 3702 Washington St Ste 202, Hollywood, FL 33021-8283 | 2017-11-07 |
| 1275046831 | Galaxy Wellness Sport and Rehabilitation Center LLC | Orthopaedic Surgery | 1951 Nw 7th St, Miami, FL 33125 | 2017-11-06 |
| Find all providers with the same taxonomy | ||||
| City | GULF BREEZE |
| Zip Code | 32561 |
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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.