Individual provider Active NPI

Jonathan Carbungco, DO

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1306576657
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS21718 Issued in FL
Practice address
2627 Riverside Ave
Jacksonville, FL 32204-4717
Phone
(904) 308-7372
NPI assigned
Jun 10, 2022
Last updated
Jul 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS21718 FL Primary

Addresses

Primary practice location

2627 Riverside Ave
Jacksonville, FL 32204-4717

Mailing address

2627 Riverside Ave
Jacksonville, FL 32204-4717
Phone (904) 308-7372

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250718001618 FL Practitioner - Family Practice 3274914346 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Alabama College of Osteopathic Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Vincents Medical Center IncGroup PAC ID 0244144558, 17 clinicians

Practice addresses (Care Compare)

1 Shircliff Way
Jacksonville, FL 32204-4748
Phone (904) 308-7300

2627 Riverside Ave
Jacksonville, FL 32204-4712
Phone (904) 308-7372

2627 Riverside Ave
Jacksonville, FL 32204-4717

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS21718FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Medical Center Inc CurrentSince Jul 17, 2025 Accepting new patients
Agape Community Health Center, Inc CurrentSince Jul 1, 2025 Accepting new patients
St Vincents Medical Center Inc CurrentSince Jul 17, 2025 Accepting new patients
Agape Community Health Center, Inc. Current Accepting new patients
Agape Community Health Center, Inc Past Accepting new patients
Agape Community Health Center, Inc Past Accepting new patients
Agape Community Health Center, Inc. Past Accepting new patients

Locations

120 King St
Jacksonville, FL 32204
Phone (904) 800-6347

1680 Dunn Ave
Ste 34
Jacksonville, FL 32218
Phone (248) 309-1665

1680 Dunn Ave
Ste 35
Jacksonville, FL 32218
Phone (904) 714-9053

1680 Dunn Ave
Ste 38
Jacksonville, FL 32218
Phone (904) 760-4905

2627 Riverside Ave
Jacksonville, FL 32204
Phone (904) 308-7372

5460 Blanding Blvd
Jacksonville, FL 32244
Phone (904) 800-6347

Interoperability endpoints

  • Direct secure messaging: jonathan.carbungco.1@12891.direct.athenahealth.com
  • Direct secure messaging: jonathan.carbungco.1@8967.direct.athenahealth.com

Organizations & group practices 7

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1654819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1306576657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2627 RIVERSIDE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044717",
            "telephone_number": "904-308-7372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 RIVERSIDE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044717",
            "telephone_number": "904-308-7372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARBUNGCO",
        "first_name": "JONATHAN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-10",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS21718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.