Individual provider Active NPI

Marielle Ameli Amoli, MD

  • Pediatric Orthopaedic Surgery Physician
  • Jacksonville, FL
National Provider Identifier
1134447030
Registry record updated Jan 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Orthopaedic Surgery PhysicianTaxonomy code 207XP3100X
License
ME126475 Issued in FL
Practice address
807 Childrens Way
Nemours Childrens Specialty Care, Jacksonville
Jacksonville, FL 32207-8426
Phone
(904) 697-3600
Fax
(904) 697-3927
NPI assigned
May 17, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Orthopaedic Surgery Physician 207XP3100X ME126475 FL Primary
Orthopaedic Surgery Physician 207X00000X TRN14929 FL

Addresses

Primary practice location

807 Childrens Way
Nemours Childrens Specialty Care, Jacksonville
Jacksonville, FL 32207-8426

Mailing address

10140 Centurion Pkwy N
Provider Enrollment
Jacksonville, FL 32256-0532

Other identifiers 1

IdentifierTypeStateIssuer
018556000MedicaidFL

Other names 1

  • Marielle Connor Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170421000520 FL Practitioner - Orthopedic Surgery 1759699531 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TRN14929FLMDOrthopaedic Surgery Physician
ME126475FLMDPediatric Orthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Nemours Foundation Current Accepting new patients
The Nemours Foundation CurrentSince Feb 8, 2017 Accepting new patients
The Nemours Foundation CurrentSince Feb 8, 2017 Accepting new patients
CC Bpci PLC Orthopaedic Surgery Past Accepting new patients

Locations

807 Childrens Way
Jacksonville, FL 32207
Phone (904) 390-3600

10140 Centurion Pkwy N
Jacksonville, FL 32256
Phone (904) 697-4100

14785 Old St Augustine Rd
Jacksonville, FL 32258
Phone (904) 292-1808

800 Prudential Dr
Jacksonville, FL 32207
Phone (904) 202-2000

Interoperability endpoints

  • Direct secure messaging: mamoli49681@direct.nemours.org

Organizations & group practices 4

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": "1274054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514937600000",
    "number": "1134447030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10140 CENTURION PKWY N",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 CHILDRENS WAY",
            "address_2": "NEMOURS CHILDRENS SPECIALTY CARE, JACKSONVILLE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078426",
            "telephone_number": "904-697-3600",
            "fax_number": "904-697-3927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMOLI",
        "first_name": "MARIELLE",
        "middle_name": "AMELI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-17",
        "last_updated": "2018-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XP3100X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": "FL",
            "license": "ME126475",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "FL",
            "license": "TRN14929",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018556000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIELLE",
            "last_name": "CONNOR",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.