Individual provider Active NPI

Emily Niles, DPM

  • Podiatrist
  • Jacksonville, FL
National Provider Identifier
1023502234
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PO4220 Issued in FL
Practice address
3636 University Blvd S BLDG C
Jacksonville, FL 32216-4250
Phone
(904) 731-1711
NPI assigned
Jun 20, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X PR552 FL
Podiatrist 213E00000X PO4220 FL Primary

Addresses

Primary practice location

3636 University Blvd S BLDG C
Jacksonville, FL 32216-4250

Mailing address

1276 12TH St N
Jacksonville Beach, FL 32250-3626
Phone (850) 324-8965

Other names 1

  • Dr. Emily Graves Professional name

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211209001652 FL Practitioner - Podiatry 0749670503 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Kent State University College of Podiatric Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Effingham Rehab Services, LLCGroup PAC ID 5597752063, shared by 3 NPIs, 143 clinicians
Adler Podiatry Clinic PLLCGroup PAC ID 0345416517, 4 clinicians

Practice addresses (Care Compare)

1390 Boone Ave Ext
Suite A23
Kingsland, GA 31548-6515
Phone (419) 221-3717

3636 University Blvd S
BLDG C
Jacksonville, FL 32216-4250
Phone (904) 731-1711

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue115
Removal of skin lesions1-10
Removal of nail tissue112
Removal or shaving of skin growth33

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PR552FLMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Adler Podiatry Clinic PLLC Podiatrist CurrentSince May 12, 2022 Accepting new patients
Pedirite Medical FL LLC CurrentSince Nov 15, 2021 Accepting new patients

Locations

60 N US Highway 17 92
Debary, FL 32713
Phone (386) 668-4426

3636 University Blvd S
Ste C
Jacksonville, FL 32216
Phone (904) 731-1711

267 Broadway
Fl 2
Brooklyn, NY 11211
Phone (716) 912-5877

Organizations & group practices 2

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 2

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": "1529452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1023502234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1276 12TH ST N",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503626",
            "telephone_number": "850-324-8965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 UNIVERSITY BLVD S BLDG C",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164250",
            "telephone_number": "904-731-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NILES",
        "first_name": "EMILY",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-20",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "FL",
            "license": "PR552",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "FL",
            "license": "PO4220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "GRAVES",
            "prefix": "DR.",
            "credential": "DPM",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.