Individual provider Active NPI

Eugene Joseph Rankin, PH.D.

  • Clinical Neuropsychologist
  • St Augustine, FL
National Provider Identifier
1104870930
Registry record updated Nov 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PY 6386 Issued in FL
Practice address
300 Kingsley Lake Dr
Ste 401
St Augustine, FL 32092-3037
Phone
(904) 495-6800
Fax
(904) 281-0495
NPI assigned
May 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PY 6386 FL Primary

Addresses

Primary practice location

300 Kingsley Lake Dr
Ste 401
St Augustine, FL 32092-3037

Mailing address

300 Kingsley Lake Dr
Ste 401
St Augustine, FL 32092-3037
Phone (904) 495-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PY 6386FLMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Halifax Healthcare Systems Inc CurrentSince Dec 16, 2016 Accepting new patients
Vericare of Florida, Inc. Past Accepting new patients
Eugene J. Rankin, PH.D., Abpp, P.L Past Accepting new patients

Locations

201 N Clyde Morris Blvd
Ste 120
Daytona Beach, FL 32114
Phone (386) 254-4029

303 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 425-2285

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.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477958400000",
    "number": "1104870930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 KINGSLEY LAKE DR",
            "address_2": "STE 401",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320923037",
            "telephone_number": "904-495-6800",
            "fax_number": "904-281-0495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 KINGSLEY LAKE DR",
            "address_2": "STE 401",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320923037",
            "telephone_number": "904-495-6800",
            "fax_number": "904-281-0495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANKIN",
        "first_name": "EUGENE",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2016-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY 6386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.