NPIMap

Individual provider Active NPI

Prabodh Ranjan, M.D.

  • Internal Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1245417609
Registry record updated Nov 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME99514 Issued in FL
Practice address
820 Prudential Dr Ste 304
Jacksonville, FL 32207-8205
Phone
(904) 346-3649
Fax
(904) 348-5627
NPI assigned
Jan 29, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X ME99514 FL
Internal Medicine Physician 207R00000X ME99514 FL Primary

Addresses

Primary practice location

820 Prudential Dr Ste 304
Jacksonville, FL 32207-8205

Mailing address

PO Box 44004
Jacksonville, FL 32231-4004
Phone (904) 346-3649

Other identifiers 4

IdentifierTypeStateIssuer
2805138-00MedicaidFL
P00712859OtherFLMEDICARE RR
139901302AMedicaidGA
K1951AOtherFLBPC MCR GROUP NO.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080730000620 FL Practitioner - Internal MedicinePractitioner - Nephrology 8224102819 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Kidney Physicians LLCGroup PAC ID 4385925650, 167 clinicians

Practice addresses (Care Compare)

2585 Herschel St
Jacksonville, FL 32204-4557
Phone (904) 388-2678

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.71 of 100Reported as individual
Quality
67.61
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME99514FLMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Kidney Physicians , LLC Nephrology CurrentSince Jul 20, 2021 Accepting new patients
Florida Kidney Physicians, LLC Nephrology CurrentSince Jul 20, 2021 Accepting new patients
Baptist Primary Care Inc Internal Medicine Past Accepting new patients

Locations

1150 N 35th Ave
Ste 620
Hollywood, FL 33021
Phone (954) 612-8173

3550 University Blvd S
Ste 202
Jacksonville, FL 32216
Phone (904) 730-2553

11236 Baptist Health Dr
Jacksonville, FL 32218
Phone (904) 202-6900

8245 Bayberry Rd
Jacksonville, FL 32256
Phone (904) 296-7775

2585 Herschel St
Jacksonville, FL 32204

1201 Monument Rd
Ste 301
Jacksonville, FL 32225
Phone (800) 636-1701

7200 Normandy Blvd
Ste 20
Jacksonville, FL 32205
Phone (904) 378-8520

905 Beach Blvd
#B
Jacksonville Beach, FL 32250
Phone (904) 246-4831

19056 NE 29th Ave
Miami, FL 33180
Phone (305) 354-4558

12662 Telecom Dr
Temple Terrace, FL 33637
Phone (813) 910-8708

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: prabodh.ranjan.1@15644.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/15644/brand/1/csg/1/fhir/r4

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 11

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": "1201564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447286400000",
    "number": "1245417609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44004",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314004",
            "telephone_number": "904-346-3649",
            "fax_number": "904-348-5627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 PRUDENTIAL DR STE 304",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078205",
            "telephone_number": "904-346-3649",
            "fax_number": "904-348-5627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANJAN",
        "first_name": "PRABODH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-29",
        "last_updated": "2015-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME99514",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME99514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2805138-00",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00712859",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139901302A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BPC MCR GROUP NO.",
            "identifier": "K1951A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.