San Jose Clinic, P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME75962 Issued in FL

Legal business name

SAN JOSE CLINIC, P.A.

Practice address

2449 University Blvd W
Jacksonville, FL 32217-2037

Phone

(904) 256-3330

Fax

(904) 256-3332

NPI assigned

Aug 19, 2009

Last updated

Feb 6, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Antoine Kassis, M.D.NPI 1477627875

Title

Medical Director

Phone

(904) 256-3330

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

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.

• Antoine Kassis, MD

  • Internal Medicine Physician
  • Jacksonville, FL
  • NPI 1477627875
  Medicare reassignment NPD Authorized official
• Elizabeth Mathew Pullukala

  • Hospitalist Physician
  • Jacksonville, FL
  • NPI 1174305742
  Medicare reassignment NPD
• Rabie Ibrahim Adam-Eldien, M.D.

  • Nephrology Physician
  • Jacksonville, FL
  • NPI 1104873355
  NPD

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

{
    "created_epoch": "1250640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738800000000",
    "number": "1083846349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 BASSWOOD CT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322594436",
            "telephone_number": "904-256-3330",
            "fax_number": "904-256-3332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2449 UNIVERSITY BLVD W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322172037",
            "telephone_number": "904-256-3330",
            "fax_number": "904-256-3332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOSE CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-19",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A",
        "authorized_official_last_name": "KASSIS",
        "authorized_official_first_name": "ANTOINE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "904-256-3330",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME75962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124628400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sonya N Samuels, L.M.T.
• Hazem Mahmoud Samy, MD
• San Jose Aspen PLLC
• San Jose Blvd Opco LLC (Aviata at San Jose)
• San Jose Chiropractic, LLC
• San Jose Family Denistry
• San Jose Imaging Center LLC (Innovative Imaging Jacksonville)
• San Jose Therapy Services LLC
• San Juan Dentistry PA
• San Juan Diagnostics LLC

• Specialist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.