Physician Group Holdings, LLC

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

Legal business name

PHYSICIAN GROUP HOLDINGS, LLC

Doing business as

Ageless Vein Center

Practice address

10210 San Jose Blvd Ste 4
Jacksonville, FL 32257-6271

Phone

(904) 990-8484

Fax

(904) 990-8485

NPI assigned

Jul 1, 2019

Last updated

Jul 1, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Megan Elizabeth Deacon-Casey, MD

Title

Medical Director

Phone

(904) 990-8484

Specialties & licenses 1

Addresses

Other names 1

• Ageless Vein Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joni Collins Ricketts, PA-C

  • Physician Assistant
  • Jacksonville, FL
  • NPI 1437178928
  NPD

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

{
    "created_epoch": "1561939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561939200000",
    "number": "1003478827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10210 SAN JOSE BLVD STE 4",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322576271",
            "telephone_number": "904-990-8484",
            "fax_number": "904-990-8485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10210 SAN JOSE BLVD STE 4",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322576271",
            "telephone_number": "904-990-8484",
            "fax_number": "904-990-8485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN GROUP HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-01",
        "last_updated": "2019-07-01",
        "status": "A",
        "authorized_official_last_name": "DEACON-CASEY",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "904-990-8484",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ageless Vein Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Physical Therapy Masters, PA
• Physical Therapy Now Holdings LLC (Physical Therapy Now Jacksonville)
• Physical Therapy Solutions Nefl, Inc.
• Physical Wellness and Rehabilitation, LLC (PhysWell Rehab)
• Physician Associates of Jacksonville, PA
• Physician Sales & Service
• Physicians Aligned
• Physicians for Quality Healthcare, Inc. (Physicians Rehabilitation)
• Physicians Group Services PA (Coastal Health)
• Physicians Group Services PA (Coastal Health)

• Vascular & Interventional Radiology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Vascular & Interventional Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2019; 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.