Individual provider Active NPI

Nolan A Gall, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • St Augustine, FL
National Provider Identifier
1245735893
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
ME161787 Issued in FL
Practice address
45 Groover Loop Ste 201
St Augustine, FL 32086-6586
Phone
(904) 634-0640
Fax
(904) 634-0203
NPI assigned
Mar 27, 2018
Last updated
Jul 28, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X ME161787 FL Primary
Pain Medicine Physician 208VP0000X ME1616787 FL

Addresses

Primary practice location

45 Groover Loop Ste 201
St Augustine, FL 32086-6586

Mailing address

6800 Southpoint Pkwy Ste 300
Jacksonville, FL 32216-8203
Phone (904) 634-0604

Other practice location 1

2 Shircliff Way Ste 605
Jacksonville, FL 32204-4762
Phone (904) 634-0640

Other practice location 2

1690 US Highway 1 S Ste F
St Augustine, FL 32084-6024
Phone (904) 634-0640

Other practice location 3

216 Southpark Cir E Ste 216
St Augustine, FL 32086-5135
Phone (904) 634-0640

Other practice location 4

3055 County Road 210 W Ste 110
St Johns, FL 32259-7001
Phone (904) 634-0640

Other practice location 5

4565 US Highway 17 Ste 200
Fleming Island, FL 32003-4823
Phone (904) 634-0640

Other practice location 6

15255 Max Legget Pkwy Ste 5300
Jacksonville, FL 32218-7274
Phone (904) 634-0640

Other practice location 7

232 Ponte Vedra Park Dr
Ponte Vedra Beach, FL 32082-6600
Phone (904) 634-0640

Other practice location 8

10475 Centurion Pkwy N Ste 220
Jacksonville, FL 32256-5004
Phone (904) 634-0640

Other practice location 9

2627 Riverside Ave Ste 300
Jacksonville, FL 32204-4717
Phone (904) 634-0640

Other identifiers 1

IdentifierTypeStateIssuer
119560200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20230803002393 FL Practitioner - Physical Medicine and Rehabilitation 3971982240 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Georgetown University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10475 Centurion Pkwy N
Suite 220
Jacksonville, FL 32256-5004
Phone (904) 634-0640

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.26 of 100Reported as individual
Quality
84.11
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME1616787FLMDPain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Orthopedic Specialists, LLC CurrentSince Jul 21, 2023 Accepting new patients
Southeast Orthopedic Specialists, LLC Pain Medicine CurrentSince Jul 21, 2023 Accepting new patients
Center for Orthopedic Research and Education, LLC Pain Medicine Past Accepting new patients

Locations

4565 US Highway 17
Ste 200
Fleming Island, FL 32003
Phone (904) 630-0640

10475 Centurion Pkwy N
Ste 220
Jacksonville, FL 32256
Phone 9046340640 ext. 1014

15255 Max Leggett Pkwy
Ste 5300
Jacksonville, FL 32218
Phone (904) 203-1386

2 Shircliff Way
Ste 605
Jacksonville, FL 32204
Phone (904) 328-5979

2627 Riverside Ave
Fl 3
Jacksonville, FL 32204
Phone 9046340640 ext. 1014

2627 Riverside Ave
Ste 300
Jacksonville, FL 32204
Phone 9046340640 ext. 1014

6800 Southpoint Pkwy
Ste 300
Jacksonville, FL 32216

232 Ponte Vedra Park Dr
Ponte Vedra Beach, FL 32082
Phone (904) 285-7546

216 Southpark Cir E
Ste 216
St Augustine, FL 32086
Phone (904) 634-0203

45 Groover Loop
Unit 201
St Augustine, FL 32086
Phone (904) 634-0604

1690 US Highway 1 S
Ste F
St Augustine Beach, FL 32084
Phone (904) 634-0460

3055 County Road 210 W
Ste 110
St Johns, FL 32259
Phone (904) 634-0203

Interoperability endpoints

  • Direct secure messaging: nolan.gall.1@22724.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1522108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1245735893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 SOUTHPOINT PKWY STE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168203",
            "telephone_number": "904-634-0604",
            "fax_number": "904-634-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 GROOVER LOOP STE 201",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320866586",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Shircliff Way Ste 605",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322044762",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203",
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            "address_type": "DOM"
        },
        {
            "address_1": "1690 US Highway 1 S Ste F",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320846024",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "216 Southpark Cir E Ste 216",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320865135",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3055 County Road 210 W Ste 110",
            "address_purpose": "LOCATION",
            "city": "St Johns",
            "state": "FL",
            "postal_code": "322597001",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4565 US Highway 17 Ste 200",
            "address_purpose": "LOCATION",
            "city": "Fleming Island",
            "state": "FL",
            "postal_code": "320034823",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15255 Max Legget Pkwy Ste 5300",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322187274",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "232 Ponte Vedra Park Dr",
            "address_purpose": "LOCATION",
            "city": "Ponte Vedra Beach",
            "state": "FL",
            "postal_code": "320826600",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10475 Centurion Pkwy N Ste 220",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322565004",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2627 Riverside Ave Ste 300",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322044717",
            "country_code": "US",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GALL",
        "first_name": "NOLAN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-27",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "FL",
            "license": "ME161787",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "FL",
            "license": "ME1616787",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119560200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.