Individual provider Active NPI

Jason Brian Widrich, MD

  • Anesthesiology Physician
  • Jacksonville, FL
National Provider Identifier
1144214834
Registry record updated Aug 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
ME87782 Issued in FL
Practice address
3625 University Blvd S
Jacksonville, FL 32216-4207
Phone
(904) 421-2119
NPI assigned
Sep 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X ME87782 FL Primary

Addresses

Primary practice location

3625 University Blvd S
Jacksonville, FL 32216-4207

Mailing address

PO Box 44008
Jacksonville, FL 32231-4008
Phone (904) 244-3660

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
I20050805000247 FL Practitioner - AnesthesiologyPractitioner - Critical Care (Intensivists) 8527097161 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Critical Care (Intensivists)
Education
University of Miami, LM Miller School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Florida Jacksonville Physicians, Inc.Group PAC ID 9133025869, 908 clinicians

Practice addresses (Care Compare)

655 W 8TH St
Jacksonville, FL 32209-6511
Phone (904) 244-6700

Hospital & facility affiliations

  • Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001

Merit-based Incentive Payment System (MIPS)

Final score
59.59 of 100Reported as apm
Quality
59.93
Promoting interoperability
0
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME87782FLMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Consultants PA Anesthesiology CurrentSince Aug 1, 2003 Accepting new patients
University of Florida Jacksonville Physicians, Inc. Anesthesiology Current Accepting new patients
University of Florida Jacksonville Physicians Inc Anesthesiology CurrentSince Aug 14, 2017 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Aug 14, 2017 Accepting new patients
Intensive Care Consortium Inc CurrentSince Dec 1, 2016 Accepting new patients

Locations

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

3625 University Blvd S
Jacksonville, FL 32216
Phone (904) 333-9404

1 Shircliff Way
Jacksonville, FL 32204
Phone (904) 332-0414

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

Interoperability endpoints

  • Direct secure messaging: jwidrich251465@direct.shands.ufl.edu
  • Direct secure messaging: jason.widrich@hca5.eclinicaldirectplus.com

Organizations & group practices 5

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 2

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": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502323200000",
    "number": "1144214834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44008",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314008",
            "telephone_number": "904-244-3660",
            "fax_number": "904-244-3425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164207",
            "telephone_number": "904-421-2119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDRICH",
        "first_name": "JASON",
        "middle_name": "BRIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2017-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME87782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.