NPIMap

Organization Active NPI

Primary Care Solutions Jacksonville LLC

  • Family Medicine Physician
  • Ponte Vedra Beach, FL
National Provider Identifier
1407555154
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRIMARY CARE SOLUTIONS JACKSONVILLE LLC
Practice address
42 Davin CT
Ponte Vedra Beach, FL 32082-1840
Phone
(904) 490-0264
NPI assigned
Mar 1, 2023
Last updated
Mar 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

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

Authorized official

Name
Katrin Casey
Title
Owner
Phone
(904) 490-0264

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

42 Davin CT
Ponte Vedra Beach, FL 32082-1840

Mailing address

42 Davin CT
Ponte Vedra Beach, FL 32082-1840
Phone (904) 490-0264

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230323002085 FL Part B Supplier - Clinic/Group Practice 9739553207 Receives reassigned benefits from 20 practitioners
Practice locations: Ponte Vedra Beach, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1677628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677628800000",
    "number": "1407555154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 DAVIN CT",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320821840",
            "telephone_number": "904-490-0264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 DAVIN CT",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320821840",
            "telephone_number": "904-490-0264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE SOLUTIONS JACKSONVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-01",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A",
        "authorized_official_last_name": "CASEY",
        "authorized_official_first_name": "KATRIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-490-0264"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponte Vedra Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.