NPIMap

Organization Active NPI

Memorial Healthcare Group Inc

Doing business as HCA Florida Memorial Hospital

  • Psychiatric Hospital Unit
  • Jacksonville, FL
National Provider Identifier
1083997779
Registry record updated Nov 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
MEMORIAL HEALTHCARE GROUP INC
Doing business as
HCA Florida Memorial Hospital
Practice address
3625 University Blvd S
Jacksonville, FL 32216-4207
Phone
(904) 399-6111
Fax
(904) 399-6849
NPI assigned
Sep 20, 2011
Last updated
Nov 5, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL HEALTHCARE GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 5, 2025

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

Authorized official

Name
Kevin McKeown
Title
Cfo
Phone
(904) 702-6573

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary

Addresses

Primary practice location

3625 University Blvd S
Jacksonville, FL 32216-4207

Mailing address

3625 University Blvd S
Jacksonville, FL 32216-4207
Phone (904) 399-6111

Other names 1

  • HCA Florida Memorial Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120921000787 FL Part A Provider - Hospital 5799788303 Practice locations: Jacksonville, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083997779. Details of each certification follow.

Hospital certification: CCN 10S179

Legal name
MEMORIAL HEALTHCARE GROUP INC
Doing business as
HCA FLORIDA MEMORIAL HOSPITAL
Organization structure
CorporationProprietary
Incorporated
Nov 15, 1994 in FL
Enrollment address
3625 University Blvd S
Jacksonville, FL 32216-4207
Hospital Psychiatric Unit
Hospital subgroups
Acute care, Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Memorial Laboratories14 organizations share this tax ID, including this one
Part of
Memorial Laboratories

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

10475 Centurion Pkwy N
Ste 100
Jacksonville, FL 32256
Phone (904) 928-1001

11701 San Jose Blvd
Jacksonville, FL 32223
Phone (708) 466-9450

3627 University Blvd S
Fl 1
Jacksonville, FL 32216
Phone (904) 399-6111

3627 University Blvd S
Fl 8
Jacksonville, FL 32216
Phone (904) 702-6377

462541 State Road 200
Yulee, FL 32097
Phone (904) 391-6300

Ownership & related parties

All disclosed owners & managing parties 48

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Michael McAlevey Individual Corporate Officer Feb 1, 2022
Jaime L Derensis Individual Corporate Officer Nov 4, 2020
HCA Inc Organization, Nashville, TN Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2012 100%
John M Franck Individual Corporate Officer Apr 18, 2016
Corporate Director Apr 18, 2016
Columbia Jacksonville Healthcare System Inc Organization, Nashville, TN Corporation, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2012 100%
Douglas L Downey Individual Corporate Officer Apr 18, 2016
Eric D Smith Individual OtherVice President - Reimbursement Mar 1, 2021
HCA Healthcare Inc Organization, Nashville, TN Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest May 10, 2016 100%
Melissa J Egan Individual Corporate Officer Nov 4, 2020
Henry Todd Maxwell Individual Corporate Officer Jan 1, 2024
Frisco Holding II Organization, Wilmington, DE Holding company, Investment firm, For-profit 5% Or Greater Indirect Ownership Interest Feb 6, 2026 16.3%
Gregary W Beasley Individual Corporate Officer Apr 18, 2016
Christopher F Wyatt Individual Corporate Officer Apr 18, 2016
Corporate Director Apr 18, 2016
John I Starling Individual Corporate Officer Oct 7, 2019
Brennon Reed Hammond Individual Corporate Officer Jun 1, 2023
W-2 Managing EmployeeCeo Jun 1, 2023
Shirley E Scharf-Cheatham Individual Corporate Officer Apr 18, 2016
Richard Hammett Individual Corporate Officer Jan 1, 2023
Julie Wickwire Individual Corporate Officer Apr 18, 2016
Brittain W Sexton Individual Corporate Officer Jan 1, 2023
John M Hackett Individual Corporate Officer Apr 18, 2016
David W. McKnight Individual Corporate Officer Sep 5, 2025
Hercules Holding II Organization, Nashville, TN Holding company, For-profit 5% Or Greater Indirect Ownership Interest May 10, 2016 14.4%
Samuel N Hazen Individual Corporate Officer Apr 18, 2016
Corporate Director Apr 18, 2016
Ronald Lee Grubbs Individual Corporate Officer Apr 18, 2016
Monica Cintado Individual Corporate Officer Oct 7, 2019
Jon Foster Individual Corporate Officer Jan 1, 2023
Sean Boyette Individual Corporate Officer Jan 1, 2023
Healthtrust Inc - the Hospital Company Organization, Nashville, TN Corporation, For-profit 5% Or Greater Indirect Ownership Interest May 10, 2016 100%
Galen Holdco LLC Organization, Nashville, TN LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest May 10, 2016 100%
Shaun Cartwright Individual Corporate Officer Sep 5, 2025
Seth a Killingbeck Individual Corporate Officer Apr 18, 2016
Ricardo Pavon Individual Corporate Officer Oct 1, 2020
Timothy Scott Noonan Individual Corporate Officer Apr 18, 2016
Natalie H Cline Individual Corporate Officer Apr 18, 2016
Michael T Bray Individual Corporate Officer Apr 18, 2016
Ryan M. Miller Individual Corporate Officer Sep 5, 2025
Matthew R Favicchio Individual Corporate Officer Sep 5, 2025
Peter J Rossell Individual Corporate Officer Jan 1, 2023
Edward Tennant Individual Corporate Officer Apr 18, 2016
Ashley T Lacaze Individual Corporate Officer Apr 15, 2019
Michael a Marks Individual Corporate Officer Sep 5, 2025
Edwin W Robinson Individual Corporate Officer Sep 5, 2025
Brad Ej Spicer Individual Corporate Officer Jan 1, 2023
Hugh Carter Tappan Individual Corporate Officer Apr 18, 2016
Kevin a Ball Individual Corporate Officer Apr 18, 2016
Jeffery McInturff Individual Corporate Officer Nov 29, 2021
Deborah H Mullin Individual Corporate Officer Apr 18, 2016
Sudeep Singh Individual Corporate Officer Sep 5, 2025

Facilities with the same owner 63

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762300800000",
    "number": "1083997779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164207",
            "telephone_number": "904-399-6111",
            "fax_number": "904-399-6849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164207",
            "telephone_number": "904-399-6111",
            "fax_number": "904-399-6849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HEALTHCARE GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL HEALTHCARE GROUP INC",
        "enumeration_date": "2011-09-20",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A",
        "authorized_official_last_name": "MCKEOWN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "904-702-6573"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "HCA Florida Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.