NPIMap

Organization Active NPI

Flagler Family Medicine P a

  • Family Medicine Physician
  • St Augustine, FL
National Provider Identifier
1215080809
Registry record updated Jul 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FLAGLER FAMILY MEDICINE P A
Practice address
130 Health Park Blvd
St Augustine, FL 32086-5776
Phone
(904) 826-3469
Fax
(904) 808-4608
NPI assigned
Jan 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2008

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

Authorized official

Name
Mrs. Ruth J Faircloth
Title
Accounts Receviable Manager
Phone
(904) 826-3469

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

130 Health Park Blvd
St Augustine, FL 32086-5776

Mailing address

130 Health Park Blvd
St Augustine, FL 32086-5776
Phone (904) 826-3469

Other identifiers 2

IdentifierTypeStateIssuer
CD6611OtherFLPALMETTO GBA RAILROAD MED
252488100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040901000477 FL Part B Supplier - Clinic/Group Practice 9335114347 Receives reassigned benefits from 27 practitioners
Practice locations: St Augustine, FL; Palm Coast, FL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1096294Flagler Family Medicine PA130 Health Park Blvd, Saint Augustine, FL 32086Certificate of waiverMar 2, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

315 W Town Pl
Saint Augustine, FL 32092

6277 A1A S
Ste AND102
Saint Augustine, FL 32080

6277 A1A S
Ste 102
Saint Augustine, FL 32080

130 Health Park Blvd
St Augustine, FL 32086
Phone (904) 826-3469

105 Southpark Blvd
Ste C302
St Augustine, FL 32086
Phone (904) 826-3469

6277 A1A S
Ste 101
St Augustine, FL 32080

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ADBCAA

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216771200000",
    "number": "1215080809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 HEALTH PARK BLVD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865776",
            "telephone_number": "904-826-3469",
            "fax_number": "904-808-4608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 HEALTH PARK BLVD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865776",
            "telephone_number": "904-826-3469",
            "fax_number": "904-808-4608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLAGLER FAMILY MEDICINE P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2008-07-23",
        "status": "A",
        "authorized_official_last_name": "FAIRCLOTH",
        "authorized_official_first_name": "RUTH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ACCOUNTS RECEVIABLE MANAGER",
        "authorized_official_telephone_number": "904-826-3469",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RAILROAD MED",
            "identifier": "CD6611",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252488100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.