NPIMap

Organization Active NPI

Angel Kids PA

  • Primary Care Clinic/Center
  • Jacksonville, FL
National Provider Identifier
1124162854
Registry record updated Jul 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ANGEL KIDS PA
Practice address
13241 Bartram Park Blvd
Suite 209
Jacksonville, FL 32258
Phone
(904) 242-4220
Fax
(904) 674-2313
NPI assigned
Feb 16, 2007
Last updated
Jul 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2015

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

Authorized official

Name
Ashraf A Abu Affan, MD
Title
President
Phone
(904) 242-4220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

13241 Bartram Park Blvd
Suite 209
Jacksonville, FL 32258

Mailing address

13241 Bartram Park Blvd.
Suite 209
Jacksonville, FL 32258
Phone (904) 242-4220

Other identifiers 1

IdentifierTypeStateIssuer
270166900MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200506000154 FL Part B Supplier - Clinic/Group Practice 1052742103 Receives reassigned benefits from 1 practitioner
Practice locations: Jacksonville, FL

National Provider Directory

National Provider Directory

Locations

13241 Bartram Park Blvd
Unit 1201
Jacksonville, FL 32258
Phone (904) 224-5437

13443 Atlantic Blvd
Jacksonville, FL 32225
Phone (904) 242-4220

2040 Riverview St
Jacksonville, FL 32208
Phone (904) 224-5437

6801 Beach Blvd
Jacksonville, FL 32216
Phone (904) 224-5437

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438041600000",
    "number": "1124162854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD.",
            "address_2": "SUITE 209",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32258",
            "telephone_number": "904-242-4220",
            "fax_number": "904-674-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD",
            "address_2": "SUITE 209",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32258",
            "telephone_number": "904-242-4220",
            "fax_number": "904-674-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL KIDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2015-07-28",
        "status": "A",
        "authorized_official_last_name": "ABU AFFAN",
        "authorized_official_first_name": "ASHRAF",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-242-4220",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270166900",
            "state": "FL"
        }
    ],
    "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 Jul 28, 2015; 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.