NPIMap

Organization Active NPI

St. Augustine Foot & Ankle, Inc

Doing business as St Augustine Rheumatology Center

  • Rheumatology Physician
  • St Augustine, FL
National Provider Identifier
1235916123
Registry record updated Sep 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
Legal business name
ST. AUGUSTINE FOOT & ANKLE, INC
Doing business as
St Augustine Rheumatology Center
Practice address
1 Saint Johns Medical Park Dr
St Augustine, FL 32086-5300
Phone
(904) 824-0869
NPI assigned
Sep 13, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2023

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

Authorized official

Name
Mia Connor
Title
Manager
Phone
(904) 824-0869

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RR0500X Primary

Addresses

Primary practice location

1 Saint Johns Medical Park Dr
St Augustine, FL 32086-5300

Mailing address

1 Saint Johns Medical Park Dr
St Augustine, FL 32086-5300
Phone (904) 824-0869

Other names 1

  • St Augustine Rheumatology Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231011002271 FL Part B Supplier - Clinic/Group Practice 5294873089 Receives reassigned benefits from 2 practitioners
Practice locations: St Augustine, FL

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
St Augustine Foot Ankle3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1694563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696032000000",
    "number": "1235916123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SAINT JOHNS MEDICAL PARK DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865300",
            "telephone_number": "904-824-0869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SAINT JOHNS MEDICAL PARK DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865300",
            "telephone_number": "904-824-0869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. AUGUSTINE FOOT & ANKLE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-13",
        "last_updated": "2023-09-30",
        "certification_date": "2023-09-30",
        "status": "A",
        "authorized_official_last_name": "CONNOR",
        "authorized_official_first_name": "MIA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "904-824-0869"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Augustine Rheumatology Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.