NPIMap

Organization Active NPI

Oceanway Medical Center, Inc.

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1245255199
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OCEANWAY MEDICAL CENTER, INC.
Practice address
11513 N Main St
Jacksonville, FL 32218-4002
Phone
(904) 751-6200
Fax
(904) 751-1600
NPI assigned
Jul 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Jeanne Micolucci
Title
President
Phone
(904) 751-6200

Specialties & licenses 1

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

Addresses

Primary practice location

11513 N Main St
Jacksonville, FL 32218-4002

Mailing address

11513 N Main St
Jacksonville, FL 32218-4002
Phone (904) 751-6200

Other identifiers 1

IdentifierTypeStateIssuer
257848400MedicaidFL

National Provider Directory

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": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1245255199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11513 N MAIN ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184002",
            "telephone_number": "904-751-6200",
            "fax_number": "904-751-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11513 N MAIN ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184002",
            "telephone_number": "904-751-6200",
            "fax_number": "904-751-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCEANWAY MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MICOLUCCI",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-751-6200"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "257848400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.