Internal Medical Group, Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

INTERNAL MEDICAL GROUP, INC.

Practice address

8614 Baymeadows Way
Suite #100
Jacksonville, FL 32256-8236

Phone

(904) 396-0450

Fax

(904) 346-3662

NPI assigned

Apr 10, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Richard D. Glock, M.D.

Title

President

Phone

(904) 396-0450

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164485223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 BAYMEADOWS WAY",
            "address_2": "SUITE #100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322568236",
            "telephone_number": "904-396-0450",
            "fax_number": "904-346-3662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8614 BAYMEADOWS WAY",
            "address_2": "SUITE #100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322568236",
            "telephone_number": "904-396-0450",
            "fax_number": "904-346-3662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GLOCK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-396-0450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSFL",
            "identifier": "77460",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.