Active NPI
Baptist Primary Care Inc
- Internal Medicine Physician
- Jacksonville, FL
National Provider Identifier
1124460761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- ME53605
- Legal business name
- BAPTIST PRIMARY CARE INC
- Practice address
- 6209 Brooks Bartram Drive
Jacksonville, FL 32258-5600 - Phone
- (904) 528-3016
- Fax
- (904) 528-3012
- NPI assigned
- Jul 24, 2013
- Last updated
- Dec 14, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Marsha Donaldson
- Title
- Vice President
- Phone
- (904) 376-3703
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | ME53605 | FL | Primary |
Addresses
Primary practice location
6209 Brooks Bartram Drive
Jacksonville, FL 32258-5600
Mailing address
PO Box 45443
Salt Lake City, UT 84145-0443
Phone (904) 202-1032
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031217000248 | FL | Part B Supplier - Clinic/Group Practice | 0648177733 |
Receives reassigned benefits from 567 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374624000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1544745600000",
"number": "1124460761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 45443",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841450443",
"telephone_number": "904-202-1032",
"fax_number": "904-376-4107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6209 BROOKS BARTRAM DRIVE",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322585600",
"telephone_number": "904-528-3016",
"fax_number": "904-528-3012"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BAPTIST PRIMARY CARE INC",
"organizational_subpart": "NO",
"enumeration_date": "2013-07-24",
"last_updated": "2018-12-14",
"status": "A",
"authorized_official_last_name": "DONALDSON",
"authorized_official_first_name": "MARSHA",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "904-376-3703"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "ME53605",
"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 Dec 14, 2018; 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.