NPIMap

Organization Active NPI

Mobile Medical Operating Company LLC

Doing business as Mobile Medical

  • General Practice Physician
  • Port St Lucie, FL
National Provider Identifier
1245983022
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MOBILE MEDICAL OPERATING COMPANY LLC
Doing business as
Mobile Medical
Practice address
1840 SE Port St Lucie Blvd Ste 1840
Port St Lucie, FL 34952-5545
Phone
(772) 221-7620
Fax
(772) 221-9903
NPI assigned
Feb 1, 2022
Last updated
Sep 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Authorized official

Name
Mr. Robert Young
Title
Secretary & Cao
Phone
(904) 733-1003

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Mental Health Counselor 101YM0800X NU
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

1840 SE Port St Lucie Blvd Ste 1840
Port St Lucie, FL 34952-5545

Mailing address

4655 Salisbury Rd Ste 110
Jacksonville, FL 32256-0957
Phone (904) 733-1003

Other identifiers 2

IdentifierTypeStateIssuer
117201700MedicaidFL
13404OtherFLAHCA

Other names 1

  • Mobile Medical Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220415001415 FL Part B Supplier - Clinic/Group Practice 1456747625 Receives reassigned benefits from 26 practitioners
Practice locations: Port St Lucie, FL

National Provider Directory

National Provider Directory

Locations

4655 Salisbury Rd
Ste 220
Jacksonville, FL 32256
Phone (904) 570-9404

4195 SW High Meadows Ave
Palm City, FL 34990
Phone (772) 221-7620

1840 SE Port St Lucie Blvd
Ste 1840
Port St Lucie, FL 34952
Phone (772) 221-7620

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1643673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1245983022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4655 SALISBURY RD STE 110",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560957",
            "telephone_number": "904-733-1003",
            "fax_number": "904-448-8855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 SE PORT ST LUCIE BLVD STE 1840",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525545",
            "telephone_number": "772-221-7620",
            "fax_number": "772-221-9903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE MEDICAL OPERATING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-01",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "SECRETARY & CAO",
        "authorized_official_telephone_number": "904-733-1003",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117201700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA",
            "identifier": "13404",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mobile Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; 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.