Organization Active NPI

RFH Jacksonville LLC

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1316709272
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RFH JACKSONVILLE LLC
Practice address
4811 Beach Blvd Ste 300
Jacksonville, FL 32207-4867
Phone
(470) 292-3820
Fax
(470) 280-9511
NPI assigned
Jan 26, 2024
Last updated
Oct 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Authorized official

Name
Mr. Randall L Haupt, MHA
Title
Executive Vice President, Sgi
Phone
(470) 292-3820

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

4811 Beach Blvd Ste 300
Jacksonville, FL 32207-4867

Mailing address

10680 Medlock Bridge Rd Ste 101
Johns Creek, GA 30097-8420
Phone (470) 292-3820

Other names 1

  • RFH Jacksonville LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240523001865 FL Part B Supplier - Clinic/Group Practice 1759723661 Receives reassigned benefits from 6 practitioners
Practice locations: Jacksonville, FL

National Provider Directory

National Provider Directory

Locations

4811 Beach Blvd
Ste 300
Jacksonville, FL 32207
Phone (470) 292-3820

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1706227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1316709272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10680 MEDLOCK BRIDGE RD STE 101",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300978420",
            "telephone_number": "470-292-3820",
            "fax_number": "470-280-9511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 BEACH BLVD STE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322074867",
            "telephone_number": "470-292-3820",
            "fax_number": "470-280-9511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RFH JACKSONVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-26",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "HAUPT",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT, SGI",
        "authorized_official_telephone_number": "470-292-3820",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RFH Jacksonville LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "RFH Jacksonville LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Oct 29, 2024; 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.