Individual provider Active NPI

Cameron David Adkisson, MD

  • Surgery Physician
  • Jacksonville, FL
National Provider Identifier
1205080652
Registry record updated Aug 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
ME105034 Issued in FL
Practice address
14540 Old Saint Augustine Rd
2571
Jacksonville, FL 32258-7418
Phone
(904) 886-2251
Fax
(904) 886-7151
NPI assigned
Nov 12, 2008
Last updated
Aug 12, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD447547 WI
Surgery Physician 208600000X 57500 MN
Surgery Physician 208600000X ME105034 FL Primary

Addresses

Primary practice location

14540 Old Saint Augustine Rd
2571
Jacksonville, FL 32258-7418

Mailing address

11945 San Jose Blvd
#300
Jacksonville, FL 32223-1613
Phone (904) 396-1725

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
I20150630001725 FL Practitioner - General Surgery 0244476810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Texas Medical Branch at Galveston, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Florida Surgeons PAGroup PAC ID 2769381391, 336 clinicians

Practice addresses (Care Compare)

14540 Old Saint Augustine Rd
Suite 2571
Jacksonville, FL 32258-7420
Phone (904) 886-2251

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.78 of 100Reported as individual
Quality
68.7
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)52
Mastectomy1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME105034FLMDSurgery Physician
MD447547WIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Florida Surgeons, PA CurrentSince Jul 27, 2015 Accepting new patients
North Florida Surgeons, PA Surgery CurrentSince Jul 27, 2015 Accepting new patients

Locations

11945 San Jose Blvd
Ste 102
Jacksonville, FL 32223
Phone (904) 268-3937

11945 San Jose Blvd
Ste 300
Jacksonville, FL 32223

14540 Old St Augustine Rd
Ste 2571
Jacksonville, FL 32258
Phone (904) 886-2251

836 Prudential Dr
Ste 1001
Jacksonville, FL 32207
Phone (904) 398-0004

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: cameron.adkisson.1@9109.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 1

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": "1226448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439337600000",
    "number": "1205080652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11945 SAN JOSE BLVD",
            "address_2": "#300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322231613",
            "telephone_number": "904-396-1725",
            "fax_number": "904-399-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14540 OLD SAINT AUGUSTINE RD",
            "address_2": "2571",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322587418",
            "telephone_number": "904-886-2251",
            "fax_number": "904-886-7151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADKISSON",
        "first_name": "CAMERON",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-12",
        "last_updated": "2015-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "MD447547",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "57500",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME105034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.