NPIMap

Organization Active NPI

Podiatry Associates of Florida Inc

  • Podiatrist
  • Jacksonville, FL
National Provider Identifier
1417137183
Registry record updated Nov 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
PODIATRY ASSOCIATES OF FLORIDA INC
Practice address
5911 Timuquana Rd Unit 300
Jacksonville, FL 32210-7897
Phone
(904) 251-5053
Fax
(904) 224-2002
NPI assigned
Nov 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2021

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

Authorized official

Name
Jeannie M Baskin
Title
Corporate Administrator
Phone
(904) 251-5053

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X Primary

Addresses

Primary practice location

5911 Timuquana Rd Unit 300
Jacksonville, FL 32210-7897

Mailing address

5911 Timuquana Rd Unit 300
Jacksonville, FL 32210-7897
Phone (904) 251-5053

Other identifiers 7

IdentifierTypeStateIssuer
65490OtherBLUE CROSS BLUE SHIELD
CI4974OtherFLRAILROAD MEDICARE
480030919OtherRAILROAD MEDICARE
65967OtherBLUE CROSS BLUE SHIELD
P00442507OtherRAILROAD MEDICARE
480026736OtherRAILROAD MEDICARE
87629OtherBLUE CROSS BLUE SHIELD

Other names 1

  • Podiatry Associates of Northeast Florida Inc Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050324000347 FL Part B Supplier - Clinic/Group Practice 8820044688 Receives reassigned benefits from 16 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jacksonville, FL; Orange Park, FL; Jacksonville Beach, FL; Clearwater, FL

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory

Locations

1914 Southside Blvd
Ste 1
Jacksonville, FL 32216
Phone (904) 726-9901

13241 Bartram Park Blvd
Unit 1809
Jacksonville, FL 32258
Phone (904) 268-3686

953 Lane Ave S
Jacksonville, FL 32205
Phone (904) 695-4447

320 Dundas Dr
Ste 7
Jacksonville, FL 32218
Phone (904) 757-4523

1384 SE Baya Dr
Lake City, FL 32025
Phone (904) 755-1428

220 Southpark Cir E
St Augustine, FL 32086
Phone (904) 808-9950

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635984000000",
    "number": "1417137183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5911 TIMUQUANA RD UNIT 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322107897",
            "telephone_number": "904-251-5053",
            "fax_number": "904-224-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5911 TIMUQUANA RD UNIT 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322107897",
            "telephone_number": "904-251-5053",
            "fax_number": "904-224-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PODIATRY ASSOCIATES OF FLORIDA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-09",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A",
        "authorized_official_last_name": "BASKIN",
        "authorized_official_first_name": "JEANNIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CORPORATE ADMINISTRATOR",
        "authorized_official_telephone_number": "904-251-5053"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "65490",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI4974",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480030919",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "65967",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00442507",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480026736",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "87629",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Podiatry Associates of Northeast Florida Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Podiatry Associates of Northeast Florida Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; 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.