Individual provider Active NPI

Madyson E Perry-Ruiz

  • Behavior Technician
  • Jacksonville, FL
National Provider Identifier
1366207201
Registry record updated Aug 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
3870 San Jose Park Dr
Jacksonville, FL 32217-4613
Phone
(904) 830-0020
NPI assigned
Feb 20, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Primary

Addresses

Primary practice location

3870 San Jose Park Dr
Jacksonville, FL 32217-4613

Mailing address

1606 Hope Valley Dr
Jacksonville, FL 32221-5539
Phone (904) 408-8213

Other practice location 1

1110 13th St Ste D
Columbus, GA 31901-2246
Phone (706) 780-1704

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Zoe Center for ABA and Development Services, LLC CurrentSince Feb 1, 2024 Accepting new patients

Locations

3870 San Jose Park Dr
Jacksonville, FL 32217
Phone (706) 507-9216

1110 13th St
Ste D
Columbus, GA 31901
Phone (706) 641-2462

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1708387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722729600000",
    "number": "1366207201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 HOPE VALLEY DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322215539",
            "telephone_number": "904-408-8213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3870 SAN JOSE PARK DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174613",
            "telephone_number": "904-830-0020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1110 13th St Ste D",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "GA",
            "postal_code": "319012246",
            "country_code": "US",
            "telephone_number": "706-780-1704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERRY-RUIZ",
        "first_name": "MADYSON",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-20",
        "last_updated": "2024-08-04",
        "certification_date": "2024-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "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 4, 2024; 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.