Individual provider Active NPI

Brandi Gilchrist Brimblecom, M.D.

  • Emergency Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1376832535
Registry record updated Sep 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME119627 Issued in FL
Practice address
841 Prudential Dr Ste 1400
Jacksonville, FL 32207-8364
Phone
(904) 396-5682
NPI assigned
Mar 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X ME119627 FL Primary

Addresses

Primary practice location

841 Prudential Dr Ste 1400
Jacksonville, FL 32207-8364

Mailing address

841 Prudential Dr Ste 1400
Jacksonville, FL 32207-8364
Phone (904) 396-5682

Other identifiers 2

IdentifierTypeStateIssuer
003149817BMedicaidGA
012379600MedicaidFL

Other names 1

  • Dr. Brandi Gilchrist Wilkes Former name

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
I20140904000400 FL Practitioner - Emergency Medicine 0446478473 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
98
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Nov 24, 2014 Accepting new patients
University of Florida Jacksonville Physicians Inc Emergency Medicine CurrentSince Nov 24, 2014 Accepting new patients
University of Florida Jacksonville Physicians Inc Current Accepting new patients
Emergency Physicians Inc Emergency Medicine CurrentSince Jul 1, 2014 Accepting new patients
Emergency Physicians Inc Emergency Medicine CurrentSince Jul 1, 2014 Accepting new patients

Locations

1250 S 18th St
Ste 202
Fernandina Beach, FL 32034
Phone (904) 202-2000

1747 Baptist Clay Dr
Ste 250
Fleming Isle, FL 32003
Phone (904) 516-1000

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

800 Prudential Dr
Jacksonville, FL 32207
Phone (904) 202-2000

841 Prudential Dr
Ste 1400
Jacksonville, FL 32207
Phone (904) 202-2000

Organizations & group practices 5

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": "1301270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569801600000",
    "number": "1376832535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 PRUDENTIAL DR STE 1400",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078364",
            "telephone_number": "904-396-5682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 PRUDENTIAL DR STE 1400",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078364",
            "telephone_number": "904-396-5682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIMBLECOM",
        "first_name": "BRANDI",
        "middle_name": "GILCHRIST",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-28",
        "last_updated": "2019-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME119627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003149817B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012379600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRANDI",
            "last_name": "WILKES",
            "middle_name": "GILCHRIST",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.