Individual provider Active NPI

Janet Underkofler, PA

  • Physician Assistant
  • Orange Park, FL
National Provider Identifier
1083613046
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA0001744 Issued in FL
Practice address
1594 Kingsley Ave
Orange Park, FL 32073-4546
Phone
(904) 264-8621
Fax
(904) 215-9418
NPI assigned
Jul 20, 2005
Last updated
Jun 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA0001744 FL Primary

Addresses

Primary practice location

1594 Kingsley Ave
Orange Park, FL 32073-4546

Mailing address

1594 Kingsley Ave
Orange Park, FL 32073-4546
Phone (904) 264-8621

Other identifiers 2

IdentifierTypeStateIssuer
002072500MedicaidFL
PA0001744OtherFLFL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090407000023 FL Practitioner - Physician Assistant 3678620754 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Family Practice Associates, LLCGroup PAC ID 8820003411, 50 clinicians

Practice addresses (Care Compare)

1594 Kingsley Ave
Orange Park, FL 32073-4546
Phone (904) 264-8621

1731 University Blvd S
Jacksonville, FL 32216-8928
Phone (904) 725-0200

4689 Hwy 17
Suite 14
Fleming Island, FL 32003-4831
Phone (904) 264-2006

4689 US Hwy 17
Suite 11
Fleming Island, FL 32003-4831
Phone (904) 278-4447

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA0001744FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Family Practice Associates LLC Family Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: janet.underkofler@hca5.eclinicaldirectplus.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1083613046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1594 KINGSLEY AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734546",
            "telephone_number": "904-264-8621",
            "fax_number": "904-215-9418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1594 KINGSLEY AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734546",
            "telephone_number": "904-264-8621",
            "fax_number": "904-215-9418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDERKOFLER",
        "first_name": "JANET",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-20",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA0001744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002072500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL LICENSE",
            "identifier": "PA0001744",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.