Individual provider Active NPI

Emilio P Supsupin Jr., M.D.

  • Neuroradiology Physician
  • Jacksonville, FL
National Provider Identifier
1225069800
Registry record updated Mar 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuroradiology PhysicianTaxonomy code 2085N0700X
License
ME152526 Issued in FL
Practice address
655 W 8TH St
Jacksonville, FL 32209-6511
Phone
(904) 244-4202
NPI assigned
Jul 5, 2006
Last updated
Mar 9, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X N5422 TX
Neuroradiology Physician 2085N0700X ME152526 FL Primary

Addresses

Primary practice location

655 W 8TH St
Jacksonville, FL 32209-6511

Mailing address

PO Box 44008
Jacksonville, FL 32231-4008
Phone (904) 244-4202

Other practice location 1

6411 Fannin St
Houston, TX 77030-1501
Phone (713) 500-7700

Other identifiers 3

IdentifierTypeStateIssuer
182077101MedicaidTX
182077102OtherTXCSHCN
8S7138OtherTXBCBSTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20060921000166 TX Practitioner - Diagnostic Radiology 0547265704 Reassigns benefits to 1 organization
I20211006000256 FL Practitioner - Diagnostic Radiology 0547265704 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ut PhysiciansGroup PAC ID 8426960360, 1,744 clinicians

Practice addresses (Care Compare)

15255 Max Leggett Pkwy
Jacksonville, FL 32218-7213
Phone (904) 383-1000

4555 Emerson Expressway
Suite 120
Jacksonville, FL 32207-4958
Phone (904) 383-1036

4555 Emerson St
Jacksonville, FL 32207-4958

5191 1St Coast Tech Pkwy
Jacksonville, FL 32224-0609
Phone (904) 427-6991

5420 W Loop S
Suite 2400
Bellaire, TX 77401-2107
Phone (713) 486-3550

6410 Fannin St
Houston, TX 77030-3005

6411 Fannin St
Houston, TX 77030-1501
Phone (713) 704-0093

6431 Fannin St
MSB2.100
Houston, TX 77030-1501
Phone (713) 500-7700

653 W 8TH St
Jacksonville, FL 32209-6511
Phone (904) 244-1680

655 W 8TH St
Jacksonville, FL 32209-6511
Phone (940) 244-4218

6700 W Loop S
Bellaire, TX 77401-4122

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.11 of 100Reported as group
Quality
69.15
Promoting interoperability
100
Improvement activities
40
Cost
73.63

Merit-based Incentive Payment System (MIPS)

Final score
59.59 of 100Reported as apm
Quality
59.93
Promoting interoperability
0
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME152526FLMDNeuroradiology Physician
N5422TXMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians, Inc. Diagnostic Radiology Current Accepting new patients
Ut Physicians Diagnostic Radiology CurrentSince Mar 1, 2012 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Sep 30, 2021 Accepting new patients
University of Florida Jacksonville Physicians Inc Neuroradiology CurrentSince Sep 30, 2021 Accepting new patients
Ut Physicians CurrentSince Mar 1, 2012 Accepting new patients
Ut Imaging - Houston LLP Diagnostic Radiology Past Accepting new patients

Locations

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

6700 West Loop S
Bellaire, TX 77401
Phone (713) 662-9729

6431 Fannin St
#2130B
Houston, TX 77030
Phone (713) 500-7631

6411 Fannin St
Houston, TX 77030
Phone (713) 500-6200

6410 Fannin St
Ste 500
Houston, TX 77030
Phone (713) 500-5714

5656 Kelley St
Houston, TX 77026
Phone (713) 566-5000

Interoperability endpoints

  • Direct secure messaging: esupsupin547307@direct.shands.ufl.edu

Organizations & group practices 6

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 4

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741478400000",
    "number": "1225069800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44008",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314008",
            "telephone_number": "904-244-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W 8TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-244-4202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6411 Fannin St",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770301501",
            "country_code": "US",
            "telephone_number": "713-500-7700",
            "fax_number": "713-500-7639",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUPSUPIN",
        "first_name": "EMILIO",
        "middle_name": "P",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2025-03-09",
        "certification_date": "2025-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "N5422",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "FL",
            "license": "ME152526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182077101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN",
            "identifier": "182077102",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "8S7138",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.