NPIMap

Organization Active NPI

Ascension Sacred Heart Gulf

  • Interventional Cardiology Physician
  • Port St Joe, FL
National Provider Identifier
1023780269
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
Legal business name
ASCENSION SACRED HEART GULF
Practice address
3871 E Highway 98 Ste 201
Port St Joe, FL 32456-5302
Phone
(850) 229-3710
Fax
(850) 229-3712
NPI assigned
Oct 5, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Authorized official

Name
Miranda Hemm
Title
Managed Care - Manager
Phone
(850) 229-3710

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X Primary

Addresses

Primary practice location

3871 E Highway 98 Ste 201
Port St Joe, FL 32456-5302

Mailing address

4205 Belfort Rd Ste 40105
Jacksonville, FL 32216-1471

Other names 1

  • SHMGG Port St. Joe Cardiology Other name

National Provider Directory

National Provider Directory
Tax ID family
Sacred Heart Hospital10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

4205 Belfort Rd
Ste 40105
Jacksonville, FL 32216

NPI Registry JSON

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

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1023780269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 40105",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3871 E HIGHWAY 98 STE 201",
            "city": "PORT ST JOE",
            "state": "FL",
            "postal_code": "324565302",
            "telephone_number": "850-229-3710",
            "fax_number": "850-229-3712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASCENSION SACRED HEART GULF",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-05",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "HEMM",
        "authorized_official_first_name": "MIRANDA",
        "authorized_official_title_or_position": "MANAGED CARE - MANAGER",
        "authorized_official_telephone_number": "850-229-3710"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHMGG Port St. Joe Cardiology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Port St Joe, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.