NPIMap

Organization Active NPI

Northeast Florida Endocrine and Diabetes Associates, PA

  • Specialist
  • St Augustine, FL
National Provider Identifier
1063883197
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
NORTHEAST FLORIDA ENDOCRINE AND DIABETES ASSOCIATES, PA
Practice address
600 Plantation Island Dr S
Suite 1
St Augustine, FL 32080-6010
Phone
(904) 384-2240
Fax
(394) 384-6055
NPI assigned
Oct 15, 2015
Last updated
Jun 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Authorized official

Name
Mrs. Elena Oravetz
Title
Credentialing
Phone
(904) 384-2240

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary
General Practice Physician 208D00000X NU

Addresses

Primary practice location

600 Plantation Island Dr S
Suite 1
St Augustine, FL 32080-6010

Mailing address

915 W Monroe St
Suite 200
Jacksonville, FL 32204-1177
Phone (904) 384-2240

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
10D2105551Northeast Florida Endocrine and Diabetes600 Plantation Island Dr Ste 1, Saint Augustine, FL 32080Certificate of waiverNov 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
NE Fla Endocrine Diab14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1444867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1063883197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 W MONROE ST",
            "address_2": "SUITE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322041177",
            "telephone_number": "904-384-2240",
            "fax_number": "904-384-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PLANTATION ISLAND DR S",
            "address_2": "SUITE 1",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320806010",
            "telephone_number": "904-384-2240",
            "fax_number": "394-384-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST FLORIDA ENDOCRINE AND DIABETES ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-15",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A",
        "authorized_official_last_name": "ORAVETZ",
        "authorized_official_first_name": "ELENA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "904-384-2240",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; 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.