NPIMap

Organization Active NPI

Podiatry Associates of Florida Inc

  • Podiatrist
  • Jacksonville, FL
National Provider Identifier
1003917675
Registry record updated May 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
PODIATRY ASSOCIATES OF FLORIDA INC
Practice address
1824 Blanding Blvd
Jacksonville, FL 32210-1904
Phone
(904) 224-2001
Fax
(904) 224-2002
NPI assigned
Sep 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2017

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

Authorized official

Name
Jeannie M Baskin
Title
Corporate Administrator
Phone
(904) 224-2001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X Primary

Addresses

Primary practice location

1824 Blanding Blvd
Jacksonville, FL 32210-1904

Mailing address

3117 Spring Glen Rd
Ste 402
Jacksonville, FL 32207-5906
Phone (904) 224-2001

Other identifiers 5

IdentifierTypeStateIssuer
CI4974OtherRAILROAD MEDICARE
CN7422OtherRAILROAD MEDICARE
DC3124OtherRAILROAD MEDICARE
65047OtherBLUE CROSS BLUE SHIELD
480025470OtherRAILROAD MEDICARE

Other names 1

  • Podiatry Associates of Northeast Florida Inc Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050324000347 FL Part B Supplier - Clinic/Group Practice 8820044688 Receives reassigned benefits from 16 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jacksonville, FL; Orange Park, FL; Jacksonville Beach, FL; Clearwater, FL

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory

Locations

1824 Blanding Blvd
Jacksonville, FL 32210
Phone (904) 387-0740

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GIBJDD

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1495756800000",
    "number": "1003917675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3117 SPRING GLEN RD",
            "address_2": "STE 402",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075906",
            "telephone_number": "904-224-2001",
            "fax_number": "904-224-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1824 BLANDING BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322101904",
            "telephone_number": "904-224-2001",
            "fax_number": "904-224-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PODIATRY ASSOCIATES OF FLORIDA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2017-05-26",
        "status": "A",
        "authorized_official_last_name": "BASKIN",
        "authorized_official_first_name": "JEANNIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CORPORATE ADMINISTRATOR",
        "authorized_official_telephone_number": "904-224-2001"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI4974",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN7422",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC3124",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "65047",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480025470",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Podiatry Associates of Northeast Florida Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.