NPIMap

Organization Active NPI

Medical Specialists of Northeast Florida PLLC

  • Internal Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1285938936
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MEDICAL SPECIALISTS OF NORTHEAST FLORIDA PLLC
Practice address
6428 Beach Blvd Ste 1a
Jacksonville, FL 32216-2813
Phone
(904) 342-0816
Fax
(904) 342-0553
NPI assigned
Jan 10, 2011
Last updated
Sep 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Authorized official

Name
Madhu Sharam
Title
Member
Phone
(904) 718-3184

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

6428 Beach Blvd Ste 1a
Jacksonville, FL 32216-2813

Mailing address

6428 Beach Blvd Ste 1a
Jacksonville, FL 32216-2813
Phone (904) 475-2039

Other practice location 1

1100 S Ponce De Leon Blvd Ste 3A
St Augustine, FL 32084-6013
Phone (904) 475-2039

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110405001104 FL Part B Supplier - Clinic/Group Practice 4587848163 Receives reassigned benefits from 10 practitioners
Practice locations: Jacksonville, FL; St Augustine, FL

National Provider Directory

National Provider Directory

Locations

6428 Beach Blvd
Ste 1A
Jacksonville, FL 32216
Phone (904) 342-0816

9471 Baymeadows Rd
Ste 1
Jacksonville, FL 32256

4869 Palm Coast Pkwy NW
Unit 2
Palm Coast, FL 32137
Phone (385) 445-2003

105 Southpark Blvd
Ste B202
St Augustine, FL 32086
Phone (904) 824-4303

1100 S Ponce de Leon Blvd
Ste 3A
St Augustine, FL 32084
Phone (904) 217-7030

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1294617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757894400000",
    "number": "1285938936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6428 BEACH BLVD STE 1A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162813",
            "telephone_number": "904-475-2039",
            "fax_number": "904-330-0668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6428 BEACH BLVD STE 1A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162813",
            "telephone_number": "904-342-0816",
            "fax_number": "904-342-0553"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 S Ponce De Leon Blvd Ste 3A",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320846013",
            "country_code": "US",
            "telephone_number": "904-475-2039",
            "fax_number": "904-330-0668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEDICAL SPECIALISTS OF NORTHEAST FLORIDA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-10",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A",
        "authorized_official_last_name": "SHARAM",
        "authorized_official_first_name": "MADHU",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "904-718-3184"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "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 Sep 15, 2025; 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.