Mainland Physicians Group LLC

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

MAINLAND PHYSICIANS GROUP LLC

Practice address

100 Arricola Ave
St Augustine, FL 32080-4515

Phone

(904) 825-4368

Fax

(904) 825-9107

NPI assigned

Nov 17, 2020

Organization subpart

No

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

Authorized official

Name

Mr. John Paul James Shaddock

Title

Director of Network Managment

Phone

(850) 341-6322

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605571200000",
    "number": "1003419763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ARRICOLA AVE",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320804515",
            "telephone_number": "904-825-4368",
            "fax_number": "904-825-9107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 ARRICOLA AVE",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320804515",
            "telephone_number": "904-825-4368",
            "fax_number": "904-825-9107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINLAND PHYSICIANS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-17",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "SHADDOCK",
        "authorized_official_first_name": "JOHN PAUL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "DIRECTOR OF NETWORK MANAGMENT",
        "authorized_official_telephone_number": "850-341-6322",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpshadddock@islanddoctors.com",
            "affiliation": "Y",
            "endpointDescription": "Email Domain",
            "affiliationName": "Roy H Hinman MD PA",
            "address_1": "100 Arricola Ave",
            "city": "St Augustine",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320804515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Geriatric Medicine (Family Medicine) Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Geriatric Medicine (Family Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.