NPIMap

Individual provider Active NPI

Brian D Tardif, PA

  • Surgical Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1164719076
Registry record updated Mar 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA9106048 Issued in FL
Practice address
10475 Centurion Pkwy N
Suite 220
Jacksonville, FL 32256-5003
Phone
(904) 634-0640
Fax
(904) 634-0203
NPI assigned
Jun 30, 2011
Last updated
Mar 25, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA9106048 FL Primary

Addresses

Primary practice location

10475 Centurion Pkwy N
Suite 220
Jacksonville, FL 32256-5003

Mailing address

6500 Bowden Rd
Suite 103
Jacksonville, FL 32216-8070
Phone (904) 634-0640

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110727000565 FL Practitioner - Physician Assistant 7113195652 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10475 Centurion Pkwy N
Jacksonville, FL 32256-5004
Phone (904) 634-0640

232 Ponte Vedra Park Dr
Ponte Vedra Beach, FL 32082-6600
Phone (904) 634-0640

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.75 of 100Reported as group
Quality
88.19
Promoting interoperability
100
Improvement activities
40
Cost
80.96

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Orthopedic Specialists, LLC CurrentSince Jul 1, 2011 Accepting new patients
Southeast Orthopedic Specialists, LLC CurrentSince Jul 1, 2011 Accepting new patients

Locations

4565 US Highway 17
Ste 200
Fleming Island, FL 32003
Phone (904) 630-0640

10475 Centurion Pkwy N
Ste 220
Jacksonville, FL 32256
Phone 9046340640 ext. 1014

10475 Centurion Pkwy N
Ste 301
Jacksonville, FL 32256
Phone (904) 308-3751

15255 Max Leggett Pkwy
Ste 5300
Jacksonville, FL 32218
Phone (904) 203-1386

2627 Riverside Ave
Ste 300
Jacksonville, FL 32204
Phone (904) 634-0460

6500 Bowden Rd
Ste 103
Jacksonville, FL 32216

232 Ponte Vedra Park Dr
Ponte Vedra Beach, FL 32082
Phone (904) 285-7546

Interoperability endpoints

  • Direct secure messaging: brian.tardif.1@22724.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1309392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427241600000",
    "number": "1164719076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 BOWDEN RD",
            "address_2": "SUITE 103",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168070",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10475 CENTURION PKWY N",
            "address_2": "SUITE 220",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322565003",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARDIF",
        "first_name": "BRIAN",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-30",
        "last_updated": "2015-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9106048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.