NPIMap

Individual provider Active NPI

Ali Reza Afshar, M.D.

  • Family Medicine Physician
  • Fleming Island, FL
National Provider Identifier
1083901177
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME129267 Issued in FL
Practice address
4565 US Highway 17 Ste 106
Fleming Island, FL 32003-4822
Phone
(904) 269-4559
Fax
(904) 269-4597
NPI assigned
Jul 9, 2011
Last updated
May 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301111119 MI
Family Medicine Physician 207Q00000X ME129267 FL Primary

Addresses

Primary practice location

4565 US Highway 17 Ste 106
Fleming Island, FL 32003-4822

Mailing address

425 W Colonial Dr Ste 303
Orlando, FL 32804-6863
Phone (904) 745-3618

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170131002832 FL Practitioner - Family Practice 8325320104 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Family Care Partners of Northeast Florida LLCGroup PAC ID 7214832245, 15 clinicians

Practice addresses (Care Compare)

4565 US Hwy 17
Suite 106
Fleming Island, FL 32003-4822
Phone (904) 269-4559

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME129267FLMDFamily Medicine Physician
4301111119MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clay Primary & Family Care LLC Family Medicine CurrentSince Dec 5, 2016 Accepting new patients
Family Care Partners of Northeast Florida LLC Family Medicine CurrentSince Mar 20, 2019 Accepting new patients
Family Care Partners of Northeast Florida LLC Family Medicine Past Accepting new patients
Elite Imaging, LLC Past Accepting new patients

Locations

4565 US Highway 17
Ste 106
Fleming Isle, FL 32003
Phone (904) 269-4559

1215 Dunn Ave
Jacksonville, FL 32218
Phone (904) 757-1998

1215 Dunn Ave
Ste A
Jacksonville, FL 32218
Phone (904) 696-8400

6484 Fort Caroline Rd
Jacksonville, FL 32277
Phone (904) 744-7300

6520 Fort Caroline Rd
Jacksonville, FL 32277
Phone (904) 725-7272

9550 Regency Square Blvd
Ste 300
Jacksonville, FL 32225
Phone (904) 744-7300

14011 Beach Blvd
Ste 210220
Jacksonville Beach, FL 32250
Phone (904) 367-2277

14444 Beach Blvd
Ste 28
Jacksonville Beach, FL 32250
Phone (904) 367-2277

865 Blanding Blvd
Orange Park, FL 32065
Phone (904) 276-1133

425 W Colonial Dr
Ste 303
Orlando, FL 32804
Phone (321) 332-6947

6900 Tavistock Lakes Blvd
Ste 300
Orlando, FL 32827
Phone (321) 332-6947

Interoperability endpoints

  • Direct secure messaging: ali.reza.afshar.1@27472.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/27472/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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 6

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": "1310169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1083901177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W COLONIAL DR STE 303",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328046863",
            "telephone_number": "904-745-3618",
            "fax_number": "904-722-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4565 US HIGHWAY 17 STE 106",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320034822",
            "telephone_number": "904-269-4559",
            "fax_number": "904-269-4597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AFSHAR",
        "first_name": "ALI",
        "middle_name": "REZA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-09",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301111119",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME129267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fleming Island, FL

Sources for this page

Verify at the official NPI Registry.