Organization Active NPI

James November PHD PA

  • Clinical Psychologist
  • Jacksonville, FL
National Provider Identifier
1104193119
Registry record updated Nov 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY2480 Issued in FL
Legal business name
JAMES NOVEMBER PHD PA
Practice address
943 Cesery Blvd
Jacksonville, FL 32211-5635
Phone
(904) 745-3111
NPI assigned
Nov 18, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2011

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

Authorized official

Name
James November, PHDNPI 1336250083
Title
Owner
Phone
(904) 421-2119

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PY2480 FL Primary

Addresses

Primary practice location

943 Cesery Blvd
Jacksonville, FL 32211-5635

Mailing address

PO Box 11729
Jacksonville, FL 32239-1729

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111201000050 FL Part B Supplier - Clinic/Group Practice 3274707211 Receives reassigned benefits from 1 practitioner
Practice locations: Ponte Vedra Beach, FL

National Provider Directory

National Provider Directory

Locations

4400 Marsh Landing Blvd
Ste 6
Ponte Vedra Beach, FL 32082
Phone (904) 256-7231

Practitioners & affiliated clinicians

Practitioners 11

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": "1321574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321574400000",
    "number": "1104193119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11729",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322391729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "943 CESERY BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322115635",
            "telephone_number": "904-745-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES NOVEMBER PHD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-18",
        "last_updated": "2011-11-18",
        "status": "A",
        "authorized_official_last_name": "NOVEMBER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-421-2119",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY2480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Nov 18, 2011; 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.