NPIMap

Organization Active NPI

NH Jax

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1275513871
Registry record updated Jul 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A64120 Issued in CA
Legal business name
NH JAX
Practice address
2080 Child St
Jacksonville, FL 32214-5005
Phone
(904) 542-7975
Fax
(904) 542-7394
NPI assigned
Jan 19, 2006
Last updated
Jul 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2008

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

Authorized official

Name
Raquel BonoNPI 1114991049
Title
Commanding Officer
Phone
(904) 542-7300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X A64120 CA Primary

Addresses

Primary practice location

2080 Child St
Jacksonville, FL 32214-5005

Mailing address

627 Carrack Dr
Saint Marys, GA 31558-2600

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216252800000",
    "number": "1275513871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 CARRACK DR",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315582600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CHILD ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322145005",
            "telephone_number": "904-542-7975",
            "fax_number": "904-542-7394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NH JAX",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2008-07-17",
        "status": "A",
        "authorized_official_last_name": "BONO",
        "authorized_official_first_name": "RAQUEL",
        "authorized_official_title_or_position": "COMMANDING OFFICER",
        "authorized_official_telephone_number": "904-542-7300"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A64120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.