| Jason Qualley, MD, CCP,LP | |
| 
					182 E Redstone Ave Ste A, Crestview, FL 32539-5371  | |
| (855) 527-7246 | |
| (833) 905-2461 | 
| Full Name | Jason Qualley | 
|---|---|
| Gender | Male | 
| Speciality | Pain Medicine - Interventional Pain Medicine | 
| Location | 182 E Redstone Ave Ste A, Crestview, Florida | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1215432901 | NPI | - | NPPES | 
| 121439800 | Medicaid | FL | 
| Entity Name | Lee Memorial Health System | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1992873319 PECOS PAC ID: 8729996608 Enrollment ID: O20031118000604  | 
| Entity Name | Gulf Coast Pain Consultants Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1669712287 PECOS PAC ID: 1658516570 Enrollment ID: O20130326000183  | 
| Entity Name | Lee Health System Inc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1942058557 PECOS PAC ID: 9335672146 Enrollment ID: O20241114001576  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Jason Qualley, MD, CCP,LP 201 Defense Hwy Ste 205, Annapolis, MD 21401-7096 Ph: (855) 527-7246  | Jason Qualley, MD, CCP,LP 182 E Redstone Ave Ste A, Crestview, FL 32539-5371 Ph: (855) 527-7246  | 
Donald Dyrone Chipman Jr., MD Pain Medicine Medicare: Accepting Medicare Assignments Practice Location: 150 E Redstone Ave Ste A, Crestview, FL 32539 Phone: 504-752-6688 Fax: 850-475-2669  | |
David Allen Norfleet, DO Pain Medicine Medicare: Not Enrolled in Medicare Practice Location: 150 E Redstone Ave, Suite A, Crestview, FL 32539 Phone: 850-689-8004 Fax: 850-689-8068  |