Individual provider Active NPI

Judy R Ashouri, MD

  • Pediatric Cardiology Physician
  • Jacksonville, FL
National Provider Identifier
1174987507
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
ME164517 Issued in FL
Practice address
841 Prudential Dr Ste 280
Jacksonville, FL 32207-8350
Phone
(904) 202-8550
Fax
(904) 393-7808
NPI assigned
Apr 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME164517 FL
Pediatric Cardiology Physician 2080P0202X ME164517 FL Primary

Addresses

Primary practice location

841 Prudential Dr Ste 280
Jacksonville, FL 32207-8350

Mailing address

PO Box 746645
Atlanta, GA 30374-6645
Phone (904) 202-2092

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
I20231027003151 FL Practitioner - Pediatric MedicinePractitioner - Cardiovascular Disease (Cardiology) 1254669542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Cardiovascular Disease (Cardiology)
Education
University of Florida College of Medicine, 2016
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

8020 Pebble Creek LN E
Ponte Vedra Beach, FL 32082-3101

PO Box
Suite 40767
Jacksonville, FL 32203

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Specialty Physicians Inc Pediatric Cardiology CurrentSince Oct 15, 2023 Accepting new patients
Baptist Specialty Physicians Inc Pediatric Cardiology CurrentSince Oct 29, 2023 Accepting new patients

Locations

841 Prudential Dr
Ste 280
Jacksonville, FL 32207
Phone (904) 202-8290

2418 E Plaza Dr
Tallahassee, FL 32308
Phone (850) 629-4861

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.

NPI Registry JSON

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

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1174987507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746645",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746645",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 PRUDENTIAL DR STE 280",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078350",
            "telephone_number": "904-202-8550",
            "fax_number": "904-393-7808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ASHOURI",
        "first_name": "JUDY",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-12",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME164517",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "FL",
            "license": "ME164517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.