NPIMap

Organization Active NPI

Im Sulzbacher Center for the Homeless, Inc

Doing business as Sulzbacher Village Pediatric Health

  • Federally Qualified Health Center (FQHC)
  • Jacksonville, FL
National Provider Identifier
1396369187
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
IM SULZBACHER CENTER FOR THE HOMELESS, INC
Doing business as
Sulzbacher Village Pediatric Health
Practice address
5455 Springfield Blvd
Jacksonville, FL 32208-5166
Phone
(904) 394-4958
NPI assigned
Jun 8, 2020
Last updated
Jun 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

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

Authorized official

Name
Cindy Funkhouser
Title
Ceo
Phone
(904) 394-4958

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

5455 Springfield Blvd
Jacksonville, FL 32208-5166

Mailing address

611 E Adams St
Jacksonville, FL 32202-2847
Phone (904) 394-5481

Other names 1

  • SULZBACHER VILLAGE PEDIATRIC HEALTH Doing business as

Medicare participation

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396369187. Details of each certification follow.

  • CCN 681147 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 681147

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SULZBACHER VILLAGE PEDIATRIC HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 27, 2019
Last certification
Jun 27, 2019
Ownership / control type
For profit – partnership
Facility address
5455 Springfield Blvd
Jacksonville, FL 32208

National Provider Directory

National Provider Directory

Locations

850 6th Ave S
Ste 500
Jacksonville Beach, FL 32250
Phone (904) 224-3550

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591574400000",
    "number": "1396369187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 E ADAMS ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322022847",
            "telephone_number": "904-394-5481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5455 SPRINGFIELD BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322085166",
            "telephone_number": "904-394-4958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IM SULZBACHER CENTER FOR THE HOMELESS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-08",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A",
        "authorized_official_last_name": "FUNKHOUSER",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-394-4958"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SULZBACHER VILLAGE PEDIATRIC HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.