NPIMap

Individual provider Active NPI

Joelle M Innocent-Simon, D.O.

  • Family Medicine Physician
  • Starke, FL
National Provider Identifier
1205970134
Registry record updated Mar 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS0006902 Issued in FL
Practice address
1550 S Water St
Starke, FL 32091-4511
Phone
(904) 368-2489
Fax
(904) 368-2493
NPI assigned
Feb 16, 2007
Last updated
Mar 22, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS0006902 FL Primary

Addresses

Primary practice location

1550 S Water St
Starke, FL 32091-4511

Mailing address

1550 S Water St
Starke, FL 32091-4511
Phone (904) 368-2489

Other identifiers 4

IdentifierTypeStateIssuer
1942270905OtherFLNPI FOR GROUP
57355OtherFLBCBS
1457448284OtherFLSHANDS STARKE MEDICAL GROUP
250170800MedicaidFL

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
I20040609000032 FL Practitioner - Family Practice 9234112798 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1993
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Lake Area Physical Therapy Inc.Group PAC ID 3678604840, 372 clinicians

Practice addresses (Care Compare)

1550 S Water St
Uf Health Family Medical Group Starke
Starke, FL 32091-4511
Phone (904) 368-2480

2001 SW 13TH St
Gainesville, FL 32608-1532
Phone (352) 265-8990

4037 NW 86TH Ter
FL 3
Gainesville, FL 32606-9277
Phone (352) 265-7777

4037 NW 86TH Terr 2ND Floor
Gainesville, FL 32606-9277

4037 NW 86TH Terr Floor
Gainesville, FL 32606-9277

PO Box
Suite 1099
Melrose, FL 32666-1099

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Merit-based Incentive Payment System (MIPS)

Final score
88.67 of 100Reported as apm
Quality
57.34
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS0006902FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc Family Medicine CurrentSince May 1, 2020 Accepting new patients
Physician Services Group of Florida, LLC Family Medicine CurrentSince Jun 8, 2020 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince May 1, 2020 Accepting new patients
Careconnectmd Florida P.a. CurrentSince Sep 15, 2025 Accepting new patients
Acv Community Services LLC Past Accepting new patients
Psgfl MSSP, LLC PastSince Jul 28, 2025 Accepting new patients

Locations

3090 Bristol St
Ste 200
Costa Mesa, CA 92626
Phone (714) 992-1182

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

1600 SW Archer Rd
#1003
Gainesville, FL 32610

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

8325 University Pkwy
Ste A
Pensacola, FL 32514
Phone (850) 324-9633

1550 S Water St
Starke, FL 32091
Phone (904) 368-2343

922 E Call St
Starke, FL 32091
Phone (904) 368-2300

Interoperability endpoints

  • Direct secure messaging: jinnocentsimon463267@direct.shands.ufl.edu
  • Direct secure messaging: joelle.innocent-simon.1@32057.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Good Samaritan CenterLive Oak, FL, CCN 105809 Skilled nursing facility Corporate Director
Operational/Managerial Control
Adp of the SNF		 Apr 1, 2025
Apr 1, 2025
Apr 22, 2025
Aviata at Big BendPerry, FL, CCN 105631 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Sep 1, 2023
Sep 1, 2023
Riverwood Healthcare & Rehabilitation CenterStarke, FL, CCN 105488 Skilled nursing facility Managing Control - Governing Body
Adp of the SNF		 Jul 1, 2024
Jul 1, 2024
Aviata at Harts HarborJacksonville, FL, CCN 105632 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2025
May 1, 2025

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300752000000",
    "number": "1205970134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 S WATER ST",
            "city": "STARKE",
            "state": "FL",
            "postal_code": "320914511",
            "telephone_number": "904-368-2489",
            "fax_number": "904-368-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 S WATER ST",
            "city": "STARKE",
            "state": "FL",
            "postal_code": "320914511",
            "telephone_number": "904-368-2489",
            "fax_number": "904-368-2493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INNOCENT-SIMON",
        "first_name": "JOELLE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-16",
        "last_updated": "2011-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS0006902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR GROUP",
            "identifier": "1942270905",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "57355",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SHANDS STARKE MEDICAL GROUP",
            "identifier": "1457448284",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250170800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Starke, FL

Sources for this page

Verify at the official NPI Registry.