NPIMap

Organization Active NPI

First Coast Psychiatric Services, P.a.

  • Psychiatry Physician
  • Orange Park, FL
National Provider Identifier
1104222801
Registry record updated Jan 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
ME112832 Issued in FL
Legal business name
FIRST COAST PSYCHIATRIC SERVICES, P.A.
Practice address
1543 Kingsley Ave Ste 14
Orange Park, FL 32073-4570
Phone
(904) 264-6977
Fax
(904) 269-0870
NPI assigned
Nov 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2022

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

Authorized official

Name
Heather Edwards
Title
Credentialing Coordinator
Phone
(904) 264-6977

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X ME112832 FL Primary

Addresses

Primary practice location

1543 Kingsley Ave Ste 14
Orange Park, FL 32073-4570

Mailing address

1543 Kingsley Ave Ste 14
Orange Park, FL 32073-4570
Phone (904) 264-6977

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141121001550 FL Part B Supplier - Clinic/Group Practice 9133441421 Receives reassigned benefits from 10 practitioners
Practice locations: Orange Park, FL

National Provider Directory

National Provider Directory

Locations

12620 Beach Blvd
Ste 3
Jacksonville, FL 32246
Phone (904) 463-3771

462 Kingsley Ave
Ste 102
Orange Park, FL 32073
Phone (904) 375-9679

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": "1415318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643328000000",
    "number": "1104222801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1543 KINGSLEY AVE STE 14",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734570",
            "telephone_number": "904-264-6977",
            "fax_number": "904-269-0870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1543 KINGSLEY AVE STE 14",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734570",
            "telephone_number": "904-264-6977",
            "fax_number": "904-269-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST COAST PSYCHIATRIC SERVICES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-07",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "904-264-6977"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME112832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; 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.