NPIMap

Organization Active NPI

Baptist Agewell Physicians Inc

  • Geriatric Medicine (Family Medicine) Physician
  • Jacksonville, FL
National Provider Identifier
1023595105
Registry record updated Mar 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
BAPTIST AGEWELL PHYSICIANS INC
Practice address
1325 San Marco Blvd Ste 300
Jacksonville, FL 32207-8567
Phone
(904) 202-4243
Fax
(904) 390-7415
NPI assigned
Jul 23, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2026

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

Authorized official

Name
Elizabeth Tibbs
Title
Vice President
Phone
(904) 202-3283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X FL Primary

Addresses

Primary practice location

1325 San Marco Blvd Ste 300
Jacksonville, FL 32207-8567

Mailing address

PO Box 746636
Atlanta, GA 30374-6636
Phone (904) 202-2092

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2274666Baptist Agewell Physicians, Inc1325 San Marco Blvd Suite 300, Jacksonville, FL 32207Certificate of waiverJan 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Baptist Agewell Physicians Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1532304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772496000000",
    "number": "1023595105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746636",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746636",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 SAN MARCO BLVD STE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078567",
            "telephone_number": "904-202-4243",
            "fax_number": "904-390-7415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST AGEWELL PHYSICIANS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-23",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A",
        "authorized_official_last_name": "TIBBS",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "904-202-3283"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Mar 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.