NPIMap

Organization Active NPI

Baptist Neurology Inc

  • Neurology Physician
  • Jacksonville Beach, FL
National Provider Identifier
1104058874
Registry record updated Apr 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
BAPTIST NEUROLOGY INC
Practice address
1370 13TH Ave S Ste 215
Jacksonville Beach, FL 32250-3206
Phone
(904) 249-1041
Fax
(904) 249-9764
NPI assigned
Aug 14, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2026

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

Authorized official

Name
Tyrone McCloud
Title
Manager, Credentials
Phone
(904) 202-5367

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1370 13TH Ave S Ste 215
Jacksonville Beach, FL 32250-3206

Mailing address

PO Box 746649
Atlanta, GA 30374-6649
Phone (904) 202-2092

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100923000562 FL Part B Supplier - Clinic/Group Practice 0345366704 Receives reassigned benefits from 63 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jacksonville, FL; Jacksonville Beach, FL; Fleming Island, FL; Fernandina Beach, FL

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Baptist Neurology Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

841 Prudential Dr
Fl 10
Jacksonville, FL 32207
Phone (904) 398-5404

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1250208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777248000000",
    "number": "1104058874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746649",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746649",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 13TH AVE S STE 215",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503206",
            "telephone_number": "904-249-1041",
            "fax_number": "904-249-9764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST NEUROLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-14",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A",
        "authorized_official_last_name": "MCCLOUD",
        "authorized_official_first_name": "TYRONE",
        "authorized_official_title_or_position": "MANAGER, CREDENTIALS",
        "authorized_official_telephone_number": "904-202-5367"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2026; 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.