Jeremy Alan Caudill, D.O.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

OS10861 Issued in FL

Practice address

2460 Old Moultrie Rd Ste 3
Saint Augustine, FL 32086-4198

Phone

(904) 797-6627

Fax

(386) 328-4125

NPI assigned

Apr 23, 2007

Last updated

Jul 16, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

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

Specialty

General Surgery

Education

Ohio University, College of Osteopathic Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Flagler Hospital Hospital, Saint Augustine, FL, CCN 100090
• Ascension St Vincent's St Johns County Hospital, St. Johns, FL, CCN 100361

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jcaudill744029@direct.shands.ufl.edu

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.

• Jeremy Caudill DO

  • Surgery Physician
  • St Augustine, FL
  • NPI 1437684032
  Medicare reassignment NPD Authorized official
• Old Moultrie Surgical Center Inc

  • Ambulatory Surgical Clinic/Center
  • St Augustine, FL
  • NPI 1144326307
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Flagler Hospital Inc

  • General Acute Care Hospital
  • St Augustine, FL
  • NPI 1144211020
  Care Compare affiliation
• Flagler Hospital, Inc.

  • Urgent Care Clinic/Center
  • St Augustine, FL
  • NPI 1447527965

  Hospital

  Care Compare affiliation
• St Vincents Health System Inc

  dba Ascension St Vincent's St. Johns County

  • General Acute Care Hospital
  • Saint Johns, FL
  • NPI 1861078651
  Care Compare affiliation

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563235200000",
    "number": "1265650295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 OLD MOULTRIE RD STE 3",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320864198",
            "telephone_number": "904-797-6627",
            "fax_number": "904-797-6028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 OLD MOULTRIE RD STE 3",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320864198",
            "telephone_number": "904-797-6627",
            "fax_number": "386-328-4125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAUDILL",
        "first_name": "JEREMY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2019-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "OS10861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002389800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003413200",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jcllc@att.net",
            "affiliation": "N",
            "endpointDescription": "Practice",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2460 Old Moultrie Rd Ste 3",
            "city": "Saint Augustine",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320864198",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Surgery Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.