NPIMap

Individual provider Active NPI

Luna I Khadour, M.D.

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1114925922
Registry record updated Jan 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME0083314 Issued in FL
Practice address
12276 San Jose Blvd
Suite 401
Jacksonville, FL 32223-8628
Phone
(904) 268-5561
Fax
(904) 268-5506
NPI assigned
Jul 14, 2005
Sex
Female
Sole proprietor
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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME0083314 FL Primary

Addresses

Primary practice location

12276 San Jose Blvd
Suite 401
Jacksonville, FL 32223-8628

Mailing address

12276 San Jose Blvd
Suite 401
Jacksonville, FL 32223-8628
Phone (904) 268-5561

Other identifiers 3

IdentifierTypeStateIssuer
ME0083314OtherFLFL LICENSE
03243OtherFLBLUE CROSS BLUE SHIELD
000984800MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address LUNA.KHADOUR@hca5.eclinicaldirectplus.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090225000638 FL Practitioner - Family Practice 2365508405 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorial Family Practice Associates, LLCGroup PAC ID 8820003411, 50 clinicians

Practice addresses (Care Compare)

12276 San Jose Blvd
Suite 401
Jacksonville, FL 32223-8660
Phone (904) 268-5561

Hospital & facility affiliations

  • Brooks Rehabilitation Home Health Home health agency, Jacksonville, FL, CCN 103174
  • HCA Florida Healthcare at Home Home health agency, Jacksonville, FL, CCN 107207
  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • HCA Florida Memorial Hospital Hospital, Jacksonville, FL, CCN 100179
  • Ascension St Vincent'S Riverside Hospital, Jacksonville, FL, CCN 100040
  • HCA Florida Orange Park Hospital Hospital, Orange Park, FL, CCN 100226
  • Ascension St Vincent'S St Johns County Hospital, St. Johns, FL, CCN 100361
  • Brooks Rehabilitation Hospital University Campus Inpatient rehabilitation facility, Jacksonville, FL, CCN 103039

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0083314FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Family Practice Associates, LLC Family Medicine CurrentSince Jul 1, 2008 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Memorial Family Practice Associates LLC Family Medicine Past Accepting new patients

Locations

1731 University Blvd S
Jacksonville, FL 32216
Phone (904) 725-0200

12276 San Jose Blvd
Ste 401
Jacksonville, FL 32223
Phone (904) 268-5561

1594 Kingsley Ave
Orange Park, FL 32073
Phone (904) 264-8621

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

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 10

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": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643328000000",
    "number": "1114925922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12276 SAN JOSE BLVD",
            "address_2": "SUITE 401",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238628",
            "telephone_number": "904-268-5561",
            "fax_number": "904-268-5506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12276 SAN JOSE BLVD",
            "address_2": "SUITE 401",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238628",
            "telephone_number": "904-268-5561",
            "fax_number": "904-268-5506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHADOUR",
        "first_name": "LUNA",
        "middle_name": "I",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-14",
        "last_updated": "2022-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0083314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL LICENSE",
            "identifier": "ME0083314",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "03243",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000984800",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "LUNA.KHADOUR@hca5.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "12276 San Jose Blvd",
            "address_2": "SUITE 401",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322238628",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.