Individual provider Active NPI

Stacy Allan White Jr., M.D.

  • Pediatric Radiology Physician
  • Jacksonville, FL
National Provider Identifier
1053750323
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Radiology PhysicianTaxonomy code 2085P0229X
License
ME144263 Issued in FL
Practice address
807 Childrens Way
Jacksonville, FL 32207-8426
Phone
(904) 697-3694
Fax
(904) 697-3927
NPI assigned
Jun 20, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Radiology Physician 2085P0229X MD465719 PA
Pediatric Radiology Physician 2085P0229X ME144263 FL Primary

Addresses

Primary practice location

807 Childrens Way
Jacksonville, FL 32207-8426

Mailing address

10140 Centurion Pkwy N
Jacksonville, FL 32256-0532
Phone (904) 697-4127

Other practice location 1

1600 SW Archer Rd
Gainesville, FL 32610-8426
Phone (352) 265-0291

Other practice location 2

3401 Civic Center Blvd
Division of Radiology
Philadelphia, PA 19104
Phone (215) 590-1959

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE, NJ, FL3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20200715000451 DE Practitioner - Diagnostic Radiology 6507110087 Reassigns benefits to 1 organization
I20200721000348 NJ Practitioner - Diagnostic Radiology 6507110087 Reassigns benefits to 1 organization
I20200727000985 FL Practitioner - Diagnostic Radiology 6507110087 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Nemours New Jersey Physician Practice, P.C. CurrentSince Jul 27, 2020 Accepting new patients
The Nemours Foundation CurrentSince Jul 1, 2020 Accepting new patients
The Nemours Foundation CurrentSince Jul 1, 2020 Accepting new patients
The Nemours Foundation CurrentSince Jul 22, 2020 Accepting new patients
The Nemours Foundation Current Accepting new patients
University of Florida Jacksonville Physicians Inc CurrentSince Aug 1, 2020 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Jan 26, 2022 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Aug 1, 2020 Accepting new patients
University of Florida Jacksonville Physicians, Inc. Current Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Jan 26, 2022 Accepting new patients

Locations

1600 Rockland Rd
Wilmington, DE 19803

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

807 Childrens Way
Jacksonville, FL 32207
Phone (904) 390-3600

10140 Centurion Pkwy N
Jacksonville, FL 32256
Phone (904) 697-4100

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

6535 Nemours Pkwy
Orlando, FL 32827
Phone (407) 567-4000

1280 Almonesson Rd
Woodbury, NJ 08096
Phone (856) 345-1401

5501 Old York Rd
Ste 3
Philadelphia, PA 19141
Phone (215) 456-7180

Interoperability endpoints

  • Direct secure messaging: swhite475552@direct.shands.ufl.edu

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1053750323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10140 CENTURION PKWY N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560532",
            "telephone_number": "904-697-4127",
            "fax_number": "904-697-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 CHILDRENS WAY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078426",
            "telephone_number": "904-697-3694",
            "fax_number": "904-697-3927"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 SW Archer Rd",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326108426",
            "country_code": "US",
            "telephone_number": "352-265-0291",
            "fax_number": "352-265-0279",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3401 Civic Center Blvd",
            "address_2": "Division of Radiology",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19104",
            "country_code": "US",
            "telephone_number": "215-590-1959",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITE",
        "first_name": "STACY",
        "middle_name": "ALLAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-20",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "PA",
            "license": "MD465719",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "FL",
            "license": "ME144263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.