Individual provider Active NPI

Kenneth Albert Terhaar, M.D.

  • Diagnostic Radiology Physician
  • Jacksonville, FL
National Provider Identifier
1245225317
Registry record updated Feb 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0101233211 Issued in VA
Practice address
3599 University Blvd S
BLDG 300
Jacksonville, FL 32216
Phone
(904) 399-5550
Fax
(904) 346-4334
NPI assigned
Sep 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 0101233211 VA Primary

Addresses

Primary practice location

3599 University Blvd S
BLDG 300
Jacksonville, FL 32216

Mailing address

2080 Child St
Jacksonville, FL 32214
Phone (904) 542-7363

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 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
I20190304000298 FL Practitioner - Diagnostic Radiology 7416296850 Reassigns benefits to 2 organizations
I20200724000727 GA Practitioner - Diagnostic Radiology 7416296850 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Uniformed Services Uhs Fe Hebert School of Med, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside Radiology Associates LLCGroup PAC ID 4486555398, 381 clinicians
Mori Bean and Brooks IncGroup PAC ID 8820077878, 966 clinicians

Practice addresses (Care Compare)

1900 Tebeau St
Suite C
Waycross, GA 31501-6357
Phone (404) 851-6577

2001 Kingsley Ave
Orange Park, FL 32073-5148
Phone (904) 399-5550

2115 Little Rd
Trinity, FL 34655-4410
Phone (904) 399-5550

3599 University Blvd S
Suite 300
Jacksonville, FL 32216-4245
Phone (404) 662-2438

4471 Glen Kernan Pkwy E
Jacksonville, FL 32224-5629
Phone (904) 399-5550

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.75 of 100Reported as group
Quality
96.18
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
78.06 of 100Reported as group
Quality
72.79
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101233211VAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Radiology Associates LLC Diagnostic Radiology CurrentSince Aug 1, 2020 Accepting new patients
Mori Bean and Brooks Inc Diagnostic Radiology CurrentSince Mar 30, 2024 Accepting new patients
Northside Imaging LLC Diagnostic Radiology PastSince Aug 2, 2020 Accepting new patients

Locations

3599 University Blvd S
Ste 300
Jacksonville, FL 32216
Phone (904) 348-3879

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

13695 US Highway 1
Sebastian, FL 32958
Phone (772) 589-3185

2115 Little Rd
Trinity, FL 34655
Phone 7278418225410

710 Center St
Columbus, GA 31901
Phone (706) 571-1000

1602 Vernon Rd
Ste 200
Lagrange, GA 30240
Phone (478) 292-7962

106 Lukken Industrial Dr W
Lagrange, GA 30240
Phone (706) 880-7204

2200 Vernon St
Lagrange, GA 30240

303 Medical Dr
Ste 405
Lagrange, GA 30240
Phone (706) 812-2229

300 Medical Dr
Ste 707
Lagrange, GA 30240
Phone (706) 803-7920

1420 Vernon Rd
Lagrange, GA 30240
Phone (706) 880-7411

1740 Lions Club Rd
Madison, GA 30650
Phone (706) 342-1667

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

1900 Tebeau St
Ste C
Waycross, GA 31501

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551225600000",
    "number": "1245225317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 CHILD ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32214",
            "telephone_number": "904-542-7363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3599 UNIVERSITY BLVD S",
            "address_2": "BLDG 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32216",
            "telephone_number": "904-399-5550",
            "fax_number": "904-346-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERHAAR",
        "first_name": "KENNETH",
        "middle_name": "ALBERT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-15",
        "last_updated": "2019-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101233211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.