Provider Demographics
NPI:1902809700
Name:CUMMINGS, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27297 CHARLICK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34602-8217
Mailing Address - Country:US
Mailing Address - Phone:352-584-7287
Mailing Address - Fax:
Practice Address - Street 1:27297 CHARLICK RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34602-8217
Practice Address - Country:US
Practice Address - Phone:352-584-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48975207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110020734OtherRAILROAD MEDICARE
FL010066084OtherRAILROAD MEDICARE
FL010058670OtherRAILROAD MEDICARE
FL043804900Medicaid
FL1902809700OtherRAILROAD MEDICARE
FL02121OtherBLUE CROSS BLUE SHIELD FL
FL010066084OtherRAILROAD MEDICARE
FL10-3865Medicare PIN
FL010058670OtherRAILROAD MEDICARE
FL02121XMedicare PIN
FL02121YMedicare PIN
FL02121OtherBLUE CROSS BLUE SHIELD FL
FL110020734OtherRAILROAD MEDICARE
FL02121BMedicare PIN
FL10-3865Medicare PIN