NPIMap

Organization Active NPI

Florida Multi Specialty Medical Group, PA

  • Physical Medicine & Rehabilitation Physician
  • Jacksonville, FL
National Provider Identifier
1356497572
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
FLORIDA MULTI SPECIALTY MEDICAL GROUP, PA
Practice address
1561 Cassat Ave
Jacksonville, FL 32210-1701
Phone
(904) 389-5193
Fax
(904) 389-5227
NPI assigned
Jan 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Todd McClerren, DC
Title
President
Phone
(904) 389-5193

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

1561 Cassat Ave
Jacksonville, FL 32210-1701

Mailing address

1561 Cassat Ave
Jacksonville, FL 32210-1701
Phone (904) 389-5193

National Provider Directory

National Provider Directory

Locations

1561 Cassat Ave
Jacksonville, FL 32210
Phone (904) 389-5139

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356497572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1561 CASSAT AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322101701",
            "telephone_number": "904-389-5193",
            "fax_number": "904-389-5227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1561 CASSAT AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322101701",
            "telephone_number": "904-389-5193",
            "fax_number": "904-389-5227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA MULTI SPECIALTY MEDICAL GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCCLERREN",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-389-5193",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; 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.