NPIMap

Individual provider Active NPI

Manoj Pulicottil, M.D.

  • Internal Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1306877972
Registry record updated May 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
234503 Issued in MA
Practice address
4205 Belfort Rd
Joe Adams BLDG, Suite 2005
Jacksonville, FL 32216-5876
Phone
(904) 398-5123
Fax
(904) 399-1962
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 055273 GA
Internal Medicine Physician 207R00000X 234503 MA Primary

Addresses

Primary practice location

4205 Belfort Rd
Joe Adams BLDG, Suite 2005
Jacksonville, FL 32216-5876

Mailing address

4205 Belfort Rd
Joe Adams BLDG, Suite 2005
Jacksonville, FL 32216-5876
Phone (904) 398-5123

Other identifiers 2

IdentifierTypeStateIssuer
2149702MedicaidMA
412705254AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130813000923 FL Practitioner - Internal Medicine 7416995055 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Vincent'S Ambulatory Care IncGroup PAC ID 2860411188, 303 clinicians

Practice addresses (Care Compare)

1801 Barrs St
Suite 120
Jacksonville, FL 32204-4738
Phone (904) 308-2006

4205 Belfort Rd
Jacksonville, FL 32216-1474

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Ambulatory Care Inc Internal Medicine CurrentSince Jul 1, 2014 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Jul 1, 2014 Accepting new patients
Candler Internal Medicine Internal Medicine Past Accepting new patients

Locations

9560 Crosshill Blvd
Ste 110
Jacksonville, FL 32222
Phone (904) 203-1296

4205 Belfort Rd
Ste 2005
Jacksonville, FL 32216
Phone (904) 339-0350

4205 Belfort Rd
Ste 3004
Jacksonville, FL 32216
Phone (904) 296-4977

4745 Sutton Park Ct
Ste 701
Jacksonville, FL 32224
Phone (904) 376-4935

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

Interoperability endpoints

  • Direct secure messaging: manoj.pulicottil.1@8967.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 11

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400803200000",
    "number": "1306877972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD",
            "address_2": "JOE ADAMS BLDG, SUITE 2005",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322165876",
            "telephone_number": "904-398-5123",
            "fax_number": "904-399-1962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD",
            "address_2": "JOE ADAMS BLDG, SUITE 2005",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322165876",
            "telephone_number": "904-398-5123",
            "fax_number": "904-399-1962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULICOTTIL",
        "first_name": "MANOJ",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2014-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "055273",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "234503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2149702",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "412705254A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.