Integrative Medical Group, USA, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

INTEGRATIVE MEDICAL GROUP, USA, LLC

Practice address

1102 A1A North
Suite 104
Ponte Vedra Beach, FL 32082

Phone

(904) 273-6533

Fax

(904) 273-6532

NPI assigned

Dec 18, 2014

Organization subpart

Yes

Parent organization

PEDIATRIC ASSOCIATES OF JACKSONVILLEAs reported in NPPES

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

Authorized official

Name

Aylin Ozdemir, M.D.

Title

Owner

Phone

(904) 233-2888

Specialties & licenses 1

Addresses

Part of

Pediatric Associates of

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/3656/brand/1/csg/1/fhir/r4

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Pediatric Associates of Jacksonville, PA

  • Pediatrics Physician
  • Ponte Vedra Beach, FL
  • NPI 1811954126
  NPPES parent name

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

{
    "created_epoch": "1418860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418860800000",
    "number": "1144628439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 A1A NORTH",
            "address_2": "SUITE 104",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "32082",
            "telephone_number": "904-273-6533",
            "fax_number": "904-273-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 A1A NORTH",
            "address_2": "SUITE 104",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "32082",
            "telephone_number": "904-273-6533",
            "fax_number": "904-273-6532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE MEDICAL GROUP, USA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC ASSOCIATES OF JACKSONVILLE",
        "enumeration_date": "2014-12-18",
        "last_updated": "2014-12-18",
        "status": "A",
        "authorized_official_last_name": "OZDEMIR",
        "authorized_official_first_name": "AYLIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-233-2888",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kai Elizabeth Hutson, LMHC
• Vivien Huynh, APRN
• Phyllis Ingram, LMHC
• Innovative Therapy Solutions Inc
• Integrated Therapy of FL LLC
• Naomi Jacobs, PH.D.
• Ashley Marie Jacoby, LMHC
• Farha Mohamed Haji Jamaldin
• Janice Wachtel, PHD, LLC
• Jba South LLC

• Primary Care Clinic/Center in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.