Individual provider Active NPI

Ryan R Shrode, ARNP

  • Family Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1194070862
Registry record updated Oct 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9186197 Issued in FL
Practice address
836 Prudential Dr Ste 1700
Jacksonville, FL 32207-8344
Phone
(904) 398-0125
Fax
(904) 398-1832
NPI assigned
Jul 19, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 9186197 FL
Family Nurse Practitioner 363LF0000X ARNP9186197 FL Primary

Addresses

Primary practice location

836 Prudential Dr Ste 1700
Jacksonville, FL 32207-8344

Mailing address

PO Box 43667
Jacksonville, FL 32203-3667
Phone (904) 720-0599

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120904000586 FL Practitioner - Nurse Practitioner 9739336397 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9186197FLMDLicensed Practical Nurse
ARNP9186197FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Cardiology, Inc. Family CurrentSince Jun 22, 2015 Accepting new patients

Locations

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

1361 13th Ave S
Ste 270
Jacksonville Beach, FL 32250
Phone (904) 241-7147

Organizations & group practices 1

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": "1342656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540512000000",
    "number": "1194070862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43667",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322033667",
            "telephone_number": "904-720-0599",
            "fax_number": "904-376-4036"
        },
        {
            "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": "SHRODE",
        "first_name": "RYAN",
        "middle_name": "R",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-19",
        "last_updated": "2018-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "9186197",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9186197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.