Jeremy Shawn Mirabile, M.D. ABPM-ADM, FASAM

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

ME88707 Issued in FL

Practice address

1030 A1A N
Ponte Vedra Beach, FL 32082-4019

Phone

(904) 551-1394

Fax

(888) 770-4284

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Awakening, Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Jacksonville, FL
  • NPI 1356502728
  NPD (past) Authorized official
• Recovery Keys, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Ponte Vedra Beach, FL
  • NPI 1497589345
  NPD (past) Authorized official
• Halifax Healthcare Systems Inc

  • Family Medicine Physician
  • Daytona Beach, FL
  • NPI 1245283530
  NPD (past)

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1295749968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 A1A N",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320824019",
            "telephone_number": "904-551-1394",
            "fax_number": "888-770-4284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 A1A N",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320824019",
            "telephone_number": "904-551-1394",
            "fax_number": "888-770-4284"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6100 Greenland Rd",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "32258",
            "country_code": "US",
            "telephone_number": "904-551-1394",
            "fax_number": "888-770-4284",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1106 A1A N Ste 201A",
            "address_purpose": "LOCATION",
            "city": "Ponte Vedra Beach",
            "state": "FL",
            "postal_code": "320824097",
            "country_code": "US",
            "telephone_number": "904-551-1394",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRABILE",
        "first_name": "JEREMY",
        "middle_name": "SHAWN",
        "name_prefix": "Dr.",
        "credential": "M.D. ABPM-ADM, FASAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "FL",
            "license": "ME88707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Russell D Metz, M.D.
• Michael J. Zalewa, LMHC,P.a.
• Milestones Child Psychology
• Elizabeth Miller, OTR/L
• Lucy S Miller, M.D.
• Miteshkumar Patel M.D., Core Continuity of Care Inc.
• Andrea Louise Mixer, PTA
• Susan Rost Monahan, OD
• Samantha Jo Monson, M.S., CCC-SLP
• Raphael Christa Montgomery, PT

• Addiction Medicine (Family Medicine) Physician in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Addiction Medicine (Family Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; 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.