NPIMap

Organization Active NPI

Jacksonville Internal Medicine

  • Internal Medicine Physician
  • Gadsden, AL
National Provider Identifier
1013093152
Registry record updated Jul 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25404 Issued in AL
Legal business name
JACKSONVILLE INTERNAL MEDICINE
Practice address
430 George Wallace Dr # 246
Gadsden, AL 35903-2280
Phone
(256) 343-1800
Fax
(256) 365-1046
NPI assigned
Oct 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2023

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

Authorized official

Name
Dr. Rey GavinoNPI 1659457794
Title
Owner
Phone
(256) 343-1800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 25404 AL Primary

Addresses

Primary practice location

430 George Wallace Dr # 246
Gadsden, AL 35903-2280

Mailing address

PO Box 550
Jacksonville, AL 36265-0550
Phone (256) 343-1800

Other identifiers 1

IdentifierTypeStateIssuer
01D1017203OtherALCLIA

National Provider Directory

National Provider Directory
Tax ID family
Jacksonville Intermed Assoc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1460 2nd Ave SW
Jacksonville, AL 36265
Phone (256) 435-2180

2270 Pelham Rd S
Jacksonville, AL 36265
Phone (256) 435-5499

Practitioners & affiliated clinicians

Practitioners 9

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": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690416000000",
    "number": "1013093152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362650550",
            "telephone_number": "256-343-1800",
            "fax_number": "256-365-1046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 GEORGE WALLACE DR # 246",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359032280",
            "telephone_number": "256-343-1800",
            "fax_number": "256-365-1046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A",
        "authorized_official_last_name": "GAVINO",
        "authorized_official_first_name": "REY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-343-1800",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "25404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "01D1017203",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gadsden, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; 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.