Olin Beverly Mauldin Jr., M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME54094 Issued in FL

Practice address

6271 Saint Augustine Rd
Ufjp San Jose Pediatric and Adolescenter Center
Jacksonville, FL 32217-2523

Phone

(904) 633-0460

Fax

(904) 633-0461

NPI assigned

Mar 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• University of Florida Jacksonville Physicians, Inc.

  • Internal Medicine Physician
  • Jacksonville, FL
  • NPI 1144276452

  Pediatrics

  Medicare reassignment NPD
• University of Florida Jacksonville Physicians Inc

  • Developmental - Behavioral Pediatrics Physician
  • Jacksonville, FL
  • NPI 1649430919
  NPD
• University of Florida Jacksonville Physicians, Inc.

  dba UF Health Imaging Center-Baymeadows

  • Physiological Laboratory
  • Jacksonville, FL
  • NPI 1831800952
  NPD

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

{
    "created_epoch": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221091200000",
    "number": "1154380285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44008",
            "address_2": "UFJP PROVIDER ENROLLMENT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6271 SAINT AUGUSTINE RD",
            "address_2": "UFJP SAN JOSE PEDIATRIC AND ADOLESCENTER CENTER",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322172523",
            "telephone_number": "904-633-0460",
            "fax_number": "904-633-0461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAULDIN",
        "first_name": "OLIN",
        "middle_name": "BEVERLY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-18",
        "last_updated": "2008-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME54094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "370001193",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0376370-02",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000473789A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Mattson, MT-BC
• Fenja Mattson, AUD
• Katherine Matty, CNM
• Tamara Matty, ARNP
• Dara Michelle Mauck, M.S., CCC-SLP
• Samantha Mauldin
• Geran Daniel Montgomery Maule, MD
• Shakayla Maultsby
• Jeannine V Mauney, MD
• Toe Toe Maung, MD

• Pediatrics Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.