OrganizationActive
Emergency Providers Group LLC
NPI 1164711206 · Emergency Medicine Physician · Fort Walton Beach, FL
Provider details
- NPI number
- 1164711206
- Entity type
- Organization
- Primary specialty
- Emergency Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Mark Penkhus, Vice President(615) 344-9551
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(82/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
15 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708
Phone: (850) 862-1111
Street-level locationGet directions
Mailing address
Po Box 741630
Atlanta, GA 30374-1630
Registry dates
- Enumerated
- 2011-03-29
- Last updated
- 2011-04-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.