NPIMap

Organization Active NPI

West Jax Skilled Nursing

  • Family Medicine Physician
  • Ponte Vedra Beach, FL
National Provider Identifier
1063898864
Registry record updated Aug 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1750382669 Issued in FL
Legal business name
WEST JAX SKILLED NURSING
Practice address
100 Cypress Lagoon CT
Ponte Vedra Beach, FL 32082-2106
Phone
(904) 783-2405
Fax
(904) 786-4981
NPI assigned
Aug 4, 2015
Last updated
Aug 4, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2015

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

Authorized official

Name
Dr. Michael Victor Sharpe, M.D.NPI 1750382669
Title
Supervisor
Phone
(904) 783-2405

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1285048280 FL
Family Medicine Physician 207Q00000X 1750382669 FL Primary

Addresses

Primary practice location

100 Cypress Lagoon CT
Ponte Vedra Beach, FL 32082-2106

Mailing address

100 Cypress Lagoon CT
Ponte Vedra Beach, FL 32082-2106
Phone (904) 783-2405

Other identifiers 1

IdentifierTypeStateIssuer
620455400MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1438646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438646400000",
    "number": "1063898864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CYPRESS LAGOON CT",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320822106",
            "telephone_number": "904-783-2405",
            "fax_number": "904-786-4981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CYPRESS LAGOON CT",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320822106",
            "telephone_number": "904-783-2405",
            "fax_number": "904-786-4981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST JAX SKILLED NURSING",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-04",
        "last_updated": "2015-08-04",
        "status": "A",
        "authorized_official_last_name": "SHARPE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "VICTOR",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "904-783-2405",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "1285048280",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "1750382669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620455400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponte Vedra Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2015; 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.