Individual provider Active NPI

Joshua Mark Yeykal, D.O.

  • Surgical Critical Care Physician
  • Orange Park, FL
National Provider Identifier
1104145622
Registry record updated Feb 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
OS16261 Issued in FL
Practice address
1887 Kingsley Ave Ste 1900
Orange Park, FL 32073-4451
Phone
(904) 276-2549
NPI assigned
May 24, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X OS16261 FL
Surgical Critical Care Physician 2086S0102X OS16261 FL Primary

Addresses

Primary practice location

1887 Kingsley Ave Ste 1900
Orange Park, FL 32073-4451

Mailing address

1548 Ansley PL
St Johns, FL 32259-5208
Phone (814) 860-1989

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190821002435 FL Practitioner - General Surgery 2264744812 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Lake Erie College of Osteopathic Medicine, Erie, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Trauma Services LLCGroup PAC ID 3971985938, 92 clinicians

Practice addresses (Care Compare)

1887 Kingsley Ave
Suite 1900
Orange Park, FL 32073-4451
Phone (904) 276-2549

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS16261FLMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Trauma Services, LLC Surgery CurrentSince Feb 1, 2023 Accepting new patients
Munson Healthcare Grayling Past Accepting new patients
Munson Healthcare Grayling Past Accepting new patients

Locations

1000 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 374-9610

14000 Fivay Rd
Hudson, FL 34667
Phone (727) 819-2929

3627 University Blvd S
Ste 305
Jacksonville, FL 32216
Phone (214) 712-2444

1887 Kingsley Ave
Ste 1900
Orange Park, FL 32073
Phone (904) 272-9981

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1274659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676332800000",
    "number": "1104145622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1548 ANSLEY PL",
            "city": "ST JOHNS",
            "state": "FL",
            "postal_code": "322595208",
            "telephone_number": "814-860-1989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1887 KINGSLEY AVE STE 1900",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734451",
            "telephone_number": "904-276-2549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YEYKAL",
        "first_name": "JOSHUA",
        "middle_name": "MARK",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-24",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "OS16261",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "FL",
            "license": "OS16261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.