NPIMap

Individual provider Active NPI

Manuel Portalatin, MD

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1255309332
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME66899 Issued in FL
Practice address
9090 Regency Square Blvd
Credentialing Department
Jacksonville, FL 32211-8119
Phone
(904) 724-5576
Fax
(904) 390-7508
NPI assigned
Mar 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME66899 FL Primary

Addresses

Primary practice location

9090 Regency Square Blvd
Credentialing Department
Jacksonville, FL 32211-8119

Mailing address

PO Box 746638
Atlanta, GA 30374-6638
Phone (904) 202-2092

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
I20100512000968 FL Practitioner - Family Practice 1850429861 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Puerto Rico School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist Primary Care IncGroup PAC ID 0648177733, 459 clinicians

Practice addresses (Care Compare)

9090 Regency Square Blvd
Jacksonville, FL 32211-8119
Phone (904) 724-5576

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.44 of 100Reported as apm
Quality
84.21
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME66899FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Primary Care Inc Family Medicine CurrentSince Oct 1, 2001 Accepting new patients
Baptist Primary Care Inc Family Medicine Current Accepting new patients
Baptist Primary Care Inc Family Medicine CurrentSince Oct 1, 2001 Accepting new patients

Locations

836 Prudential Dr
Ste 1207
Jacksonville, FL 32207
Phone (904) 396-8656

810 Lane Ave S
Jacksonville, FL 32205
Phone (904) 693-2389

9090 Regency Square Blvd
Jacksonville, FL 32211
Phone (904) 724-5576

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IBJGBD
  • Direct secure messaging: mportalatin28266@baptisthealthsystemjacksonville.direct-ci.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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1255309332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746638",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746638",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9090 REGENCY SQUARE BLVD",
            "address_2": "CREDENTIALING DEPARTMENT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322118119",
            "telephone_number": "904-724-5576",
            "fax_number": "904-390-7508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTALATIN",
        "first_name": "MANUEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME66899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.