Individual provider Active NPI

Paul H Dillahunt II, MD

  • Nuclear Cardiology Physician
  • Jacksonville, FL
National Provider Identifier
1184680985
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nuclear Cardiology PhysicianTaxonomy code 207UN0901X
License
ME23103 Issued in FL
Practice address
836 Prudential Dr Ste 1700
Jacksonville, FL 32207-8344
Phone
(904) 398-0125
Fax
(904) 398-1832
NPI assigned
Apr 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X ME23103 FL
Nuclear Cardiology Physician 207UN0901X ME23103 FL Primary
Cardiovascular Disease Physician 207RC0000X ME23103 FL

Addresses

Primary practice location

836 Prudential Dr Ste 1700
Jacksonville, FL 32207-8344

Mailing address

PO Box 746652
Atlanta, GA 30374-6652
Phone (904) 202-2092

Other identifiers 1

IdentifierTypeStateIssuer
036771100MedicaidFL

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101020000630 FL Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 6709839889 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
95.44 of 100Reported as apm
Quality
84.21
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME23103FLMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ecg Associates of Jacksonville P a CurrentSince Jul 6, 2013 Accepting new patients
Baptist Cardiology, Inc. Cardiovascular Disease CurrentSince May 1, 2012 Accepting new patients
Memorial Ekg Associates Past Accepting new patients
Southern Heart Group, P.a. Past Accepting new patients
Southern Heart Group Cardiovascular Disease Past Accepting new patients

Locations

1348 S 18th St
Ste 200
Fernandina Beach, FL 32034
Phone (904) 202-6683

1250 S 18th St
Fernandina Beach, FL 32034
Phone (904) 202-2087

820 Prudential Dr
Ste 615
Jacksonville, FL 32207

836 Prudential Dr
Ste 1700
Jacksonville, FL 32207
Phone (904) 398-0125

820 Prudential Dr
Ste 112
Jacksonville, FL 32207
Phone (904) 396-5996

800 Prudential Dr
Jacksonville, FL 32207
Phone (904) 202-2000

3599 University Blvd S
Ste 1106
Jacksonville, FL 32216
Phone (904) 398-3760

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1184680985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746652",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746652",
            "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": "836 PRUDENTIAL DR STE 1700",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078344",
            "telephone_number": "904-398-0125",
            "fax_number": "904-398-1832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLAHUNT",
        "first_name": "PAUL",
        "middle_name": "H",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "FL",
            "license": "ME23103",
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "FL",
            "license": "ME23103",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME23103",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036771100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.