NPIMap

Organization Active NPI

Paul D Jayachandra M D P a

  • Specialist
  • St Augustine, FL
National Provider Identifier
1295870830
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
ME0066989 Issued in FL
Legal business name
PAUL D JAYACHANDRA M D P A
Practice address
1851 Old Moultrie Rd Ste a
St Augustine, FL 32084-4167
Phone
(904) 824-7476
Fax
(904) 824-7870
NPI assigned
Feb 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

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

Authorized official

Name
Sander RichiezNPI 1255164422
Title
Office Manager
Phone
(305) 807-8807

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X ME0066989 FL Primary

Addresses

Primary practice location

1851 Old Moultrie Rd Ste a
St Augustine, FL 32084-4167

Mailing address

1851 Old Moultrie Rd Ste a
St Augustine, FL 32084-4167
Phone (904) 824-7476

Other identifiers 13

IdentifierTypeStateIssuer
26220OtherFLBCBS FLORIDA
26220YOtherFLMEDICARE PROVIDER NUMBER
5777008OtherFLAETNA
94163841OtherFLWAUSA BENIFITS
AA919OtherFLMEDICARE PTAN
206068OtherFLAVMED
376531801MedicaidFL
390006717OtherFLRAILROAD MEDICARE
110132302OtherFLUNITED HEALTHCARE
26220YOtherFLMEDICARE PTAN NUMBER
150095OtherFLWELLCARE
150095OtherFLHEALTHEASE
376531800MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070517000120 FL Part B Supplier - Clinic/Group Practice 3779680236 Receives reassigned benefits from 2 practitioners
Practice locations: Saint Augustine, FL; Patlaka, FL

National Provider Directory

National Provider Directory

Locations

1851 Old Moultrie Rd
Ste A
St Augustine, FL 32084
Phone (904) 824-7476

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776729600000",
    "number": "1295870830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1851 OLD MOULTRIE RD STE A",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320844167",
            "telephone_number": "904-824-7476",
            "fax_number": "904-824-7870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1851 OLD MOULTRIE RD STE A",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320844167",
            "telephone_number": "904-824-7476",
            "fax_number": "904-824-7870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL D JAYACHANDRA M D P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A",
        "authorized_official_last_name": "RICHIEZ",
        "authorized_official_first_name": "SANDER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "305-807-8807"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME0066989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FLORIDA",
            "identifier": "26220",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "26220Y",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5777008",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WAUSA BENIFITS",
            "identifier": "94163841",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "AA919",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "206068",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "376531801",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "390006717",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "110132302",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN NUMBER",
            "identifier": "26220Y",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "150095",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHEASE",
            "identifier": "150095",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "376531800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2026; 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.