NPIMap

Organization Active NPI

Sacred Heart Medical Group

  • Internal Medicine Physician
  • Lynn Haven, FL
National Provider Identifier
1386316610
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SACRED HEART MEDICAL GROUP
Practice address
725 Ohio Ave
Lynn Haven, FL 32444-1757
Phone
(850) 804-3749
Fax
(850) 804-3750
NPI assigned
Oct 5, 2021
Last updated
Oct 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Authorized official

Name
Jean Vallier
Title
Director-Managed Care
Phone
(850) 804-3749

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

725 Ohio Ave
Lynn Haven, FL 32444-1757

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623

Other names 1

  • SHMG Primary Care at Lynn Haven Other name

National Provider Directory

National Provider Directory
Tax ID family
Sacred Heart Specialty99 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1386316610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 OHIO AVE",
            "city": "LYNN HAVEN",
            "state": "FL",
            "postal_code": "324441757",
            "telephone_number": "850-804-3749",
            "fax_number": "850-804-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED HEART MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-05",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "VALLIER",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "DIRECTOR-MANAGED CARE",
        "authorized_official_telephone_number": "850-804-3749"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHMG Primary Care at Lynn Haven",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lynn Haven, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.