Flagler Professional Health Care Services, Inc.

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

FLAGLER PROFESSIONAL HEALTH CARE SERVICES, INC.

Practice address

351 Town Plaza Ave
Ste 101
Ponte Vedra, FL 32081

Phone

(904) 819-4602

Fax

(904) 819-4426

NPI assigned

Feb 14, 2020

Organization subpart

Yes

Parent organization

FLAGLER PROFESSIONAL HEALTH CARE SERVICES, INC.As reported in NPPES

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

Authorized official

Name

John Wells Franks

Title

Delegated Official

Phone

(904) 819-4065

Specialties & licenses 5

Addresses

Other names 1

• Flagler Health Imaging Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Flagler Professional Health Care Services, Inc.

  • Radiology Clinic/Center
  • St Augustine, FL
  • NPI 1396300133

  O20180504000249

  Same enrollment
• Flagler Professional Health Care Services, Inc.

  • Cardiovascular Disease Physician
  • Jacksonville, FL
  • NPI 1891207551

  O20180504000249

  Same enrollment

Part of

Flagler Professional Health

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Flagler Hospital

  • Psychiatric Hospital Unit
  • St Augustine, FL
  • NPI 1942475074

  Member Of

  NPD member

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

{
    "created_epoch": "1581638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581638400000",
    "number": "1407489743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3266",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320853266",
            "telephone_number": "904-819-4602",
            "fax_number": "904-819-4426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 TOWN PLAZA AVE",
            "address_2": "STE 101",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "32081",
            "telephone_number": "904-819-4602",
            "fax_number": "904-819-4426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLAGLER PROFESSIONAL HEALTH CARE SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLAGLER PROFESSIONAL HEALTH CARE SERVICES, INC.",
        "enumeration_date": "2020-02-14",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A",
        "authorized_official_last_name": "FRANKS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WELLS",
        "authorized_official_title_or_position": "DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "904-819-4065"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Flagler Health Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kaitlin Fogarty

• Radiology Clinic/Center in Ponte Vedra, FL
• Providers in Ponte Vedra, FL by specialty
• Radiology Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.