Individual provider Active NPI

Jami Ann Rothe Kinnucan, M.D.

  • Gastroenterology Physician
  • Jacksonville, FL
National Provider Identifier
1003045634
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
ME152798 Issued in FL
Practice address
4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone
(904) 953-2000
NPI assigned
Jul 2, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 1025056458 IL
Internal Medicine Physician 207R00000X 4301106776 MI
Gastroenterology Physician 207RG0100X 4301106776 MI
Gastroenterology Physician 207RG0100X 74138 MN
Gastroenterology Physician 207RG0100X ME152798 FL Primary

Addresses

Primary practice location

4500 San Pablo Rd S
Jacksonville, FL 32224-1865

Mailing address

4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone (904) 953-2000

Other practice location 1

200 1st St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jkinnucan1640212@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, FL, MN3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20150720000072 MI Practitioner - GastroenterologyPractitioner - Internal Medicine 9133432230 Reassigns benefits to 1 organization
I20211210001527 FL Practitioner - Gastroenterology 9133432230 Reassigns benefits to 1 organization
I20231004001450 MN Practitioner - Gastroenterology 9133432230 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of Chicago, Pritzker School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mayo Clinic JacksonvilleGroup PAC ID 5698689297, 1,595 clinicians

Practice addresses (Care Compare)

4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone (904) 953-2000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy71
Upper gastrointestinal (GI) endoscopy for acid reflux48

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1025056458ILMDInternal Medicine Physician
4301106776MIMDGastroenterology Physician
74138MNMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Gastroenterology Current Accepting new patients
Mayo Clinic Jacksonville CurrentSince Dec 7, 2021 Accepting new patients
Mayo Clinic CurrentSince Sep 18, 2023 Accepting new patients
Mayo Clinic CurrentSince Sep 18, 2023 Accepting new patients
Metropolitan Hospital Internal Medicine CurrentSince Jun 1, 2017 Accepting new patients
Mayo Clinic Jacksonville CurrentSince Dec 7, 2021 Accepting new patients

Locations

4500 San Pablo Rd S
Jacksonville, FL 32224
Phone (904) 721-4815

5900 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 252-3243

2122 Health Dr SW
Ste 150
Wyoming, MI 49519
Phone (616) 252-5716

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

Interoperability endpoints

  • Direct secure messaging: jkinnucan657721@direct.med.umich.edu
  • Direct secure messaging: jkinnucan1640212@ehrdirect.mayoclinicmsg.org
  • Direct secure messaging: jkinnucan69644@direct.metrohealth.net
  • FHIR API: https://interconapps.uchospitals.edu/PRD-FHIR-Proxy/api/FHIR/R4/

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1003045634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 SAN PABLO RD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241865",
            "telephone_number": "904-953-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 SAN PABLO RD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241865",
            "telephone_number": "904-953-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559050001",
            "country_code": "US",
            "telephone_number": "507-284-2511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KINNUCAN",
        "first_name": "JAMI",
        "middle_name": "ANN ROTHE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-02",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "1025056458",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301106776",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "4301106776",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MN",
            "license": "74138",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "ME152798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkinnucan1640212@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "4500 San Pablo Rd S",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322241865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.