Individual provider Active NPI

Konstantinos Maniatakis, APRN

  • Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1396272340
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN9310132 Issued in FL
Practice address
915 W Monroe St Ste 200
Jacksonville, FL 32204-1177
Phone
(904) 384-2240
NPI assigned
May 20, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN9310132 FL Primary
Family Nurse Practitioner 363LF0000X APRN9310132 FL

Addresses

Primary practice location

915 W Monroe St Ste 200
Jacksonville, FL 32204-1177

Mailing address

915 W Monroe St Ste 200
Jacksonville, FL 32204-1177
Phone (904) 384-2240

Other names 1

  • Kosta Maniatakis Professional 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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170814000025 FL Practitioner - Nurse Practitioner 6901177765 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

915 W Monroe St
Suite 200
Jacksonville, FL 32204-1177
Phone (904) 384-2240

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.44 of 100Reported as apm
Quality
84.21
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN9310132FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North East Florida Endocrine and Diabetes Assoc PA CurrentSince Jul 10, 2017 Accepting new patients
Northeast Florida Endocrine and Diabetes Associates PA CurrentSince Jul 10, 2017 Accepting new patients

Locations

915 W Monroe St
Ste 200
Jacksonville, FL 32204

1375 Roberts Dr
Ste 206
Jax Bch, FL 32250
Phone (904) 247-1456

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1495238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1396272340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 W MONROE ST STE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322041177",
            "telephone_number": "904-384-2240",
            "fax_number": "904-486-2314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 W MONROE ST STE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322041177",
            "telephone_number": "904-384-2240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANIATAKIS",
        "first_name": "KONSTANTINOS",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-20",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN9310132",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN9310132",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KOSTA",
            "last_name": "MANIATAKIS",
            "credential": "ARNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.