Individual provider Active NPI

Brian Christopher Orcullo, APRN

  • Family Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1013639160
Registry record updated Jan 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11021315 Issued in FL
Practice address
4796 Hodges Blvd Ste 101
Jacksonville, FL 32224-2209
Phone
(904) 449-7246
NPI assigned
Sep 15, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN11021315 FL Primary

Addresses

Primary practice location

4796 Hodges Blvd Ste 101
Jacksonville, FL 32224-2209

Mailing address

139 Boylston CT
Saint Augustine, FL 32092-0108
Phone (904) 859-7891

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221111000622 FL Practitioner - Nurse Practitioner 1052788650 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Institute of Pain Medicine LLCGroup PAC ID 4385769686, 38 clinicians

Practice addresses (Care Compare)

4796 Hodges Blvd
Suite 101
Jacksonville, FL 32224-2209
Phone (904) 449-7246

Hospital & facility affiliations

  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11021315FLMDFamily Nurse Practitioner

Organizations & group practices 1

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": "1663200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672531200000",
    "number": "1013639160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 BOYLSTON CT",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320920108",
            "telephone_number": "904-859-7891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4796 HODGES BLVD STE 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322242209",
            "telephone_number": "904-449-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORCULLO",
        "first_name": "BRIAN",
        "middle_name": "CHRISTOPHER",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-15",
        "last_updated": "2023-01-01",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11021315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.