NPIMap

Individual provider Active NPI

Memorie Vanessa Caldwell, MD

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1194245159
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME147306 Issued in FL
Practice address
6488 103Rd St Ste B
Jacksonville, FL 32210-7161
Phone
(904) 450-6810
Fax
(904) 450-6729
NPI assigned
Jun 21, 2017
Last updated
Dec 3, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X ME147306 FL Primary

Addresses

Primary practice location

6488 103Rd St Ste B
Jacksonville, FL 32210-7161

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623
Phone (904) 450-6017

Other practice location 1

29 S Paca St
Baltimore, MD 21201-1771
Phone (667) 214-1867

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
I20201207002883 FL Practitioner - Family Practice 3274808126 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Howard University College of Medicine, 2017
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
St Vincent's Ambulatory Care IncGroup PAC ID 2860411188, 303 clinicians
Lake Area Physical Therapy Inc.Group PAC ID 3678604840, 372 clinicians

Practice addresses (Care Compare)

6488 103Rd St
Suite B
Jacksonville, FL 32210-7161
Phone (904) 450-6810

PO Box
Suite 1099
Melrose, FL 32666-1099

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Ambulatory Care Inc CurrentSince Dec 2, 2020 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Dec 2, 2020 Accepting new patients

Locations

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

6488 103rd St
Ste B
Jacksonville, FL 32210
Phone (904) 450-6810

Interoperability endpoints

  • Direct secure messaging: memorie.caldwell.1@31104.direct.athenahealth.com
  • Direct secure messaging: memorie.caldwell.1@8967.direct.athenahealth.com

Organizations & group practices 3

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1194245159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623",
            "telephone_number": "904-450-6017",
            "fax_number": "904-450-6041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6488 103RD ST STE B",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322107161",
            "telephone_number": "904-450-6810",
            "fax_number": "904-450-6729"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29 S Paca St",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212011771",
            "country_code": "US",
            "telephone_number": "667-214-1867",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CALDWELL",
        "first_name": "MEMORIE",
        "middle_name": "VANESSA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-21",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME147306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.