NPIMap

Organization Active NPI

Florida Physician Specialists LLC

Doing business as Kasraeian Urology

  • Urology Physician
  • Jacksonville, FL
National Provider Identifier
1083959563
Registry record updated Dec 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
FLORIDA PHYSICIAN SPECIALISTS LLC
Doing business as
Kasraeian Urology
Practice address
6269 Beach Blvd
Suite 2
Jacksonville, FL 32216-2768
Phone
(904) 727-7955
Fax
(904) 727-7976
NPI assigned
Dec 10, 2012
Last updated
Dec 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2012

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

Authorized official

Name
Ahmad Kasraeian, MDNPI 1659374320
Title
Ceo
Phone
(904) 727-7955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X NU Primary
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician 2088F0040X NU

Addresses

Primary practice location

6269 Beach Blvd
Suite 2
Jacksonville, FL 32216-2768

Mailing address

6269 Beach Blvd
Suite 2
Jacksonville, FL 32216-2768
Phone (904) 727-7955

Other names 1

  • Kasraeian Urology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121130000298 FL Part B Supplier - Clinic/Group Practice 4486806213 Receives reassigned benefits from 53 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jacksonville, FL; Orange Park, FL; Jacksonville Beach, FL

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1355097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355097600000",
    "number": "1083959563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6269 BEACH BLVD",
            "address_2": "SUITE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162768",
            "telephone_number": "904-727-7955",
            "fax_number": "904-727-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6269 BEACH BLVD",
            "address_2": "SUITE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162768",
            "telephone_number": "904-727-7955",
            "fax_number": "904-727-7976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA PHYSICIAN SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-10",
        "last_updated": "2012-12-10",
        "status": "A",
        "authorized_official_last_name": "KASRAEIAN",
        "authorized_official_first_name": "AHMAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-727-7955",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2088F0040X",
            "taxonomy_group": "",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kasraeian Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.