NPIMap

Organization Active NPI

St Vincents Ambulatory Care Inc

  • Neurological Surgery Physician
  • Jacksonville, FL
National Provider Identifier
1417987124
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
ST VINCENTS AMBULATORY CARE INC
Practice address
2 Shircliff Way
Suite 600
Jacksonville, FL 32204-4742
Phone
(904) 308-6769
Fax
(904) 308-4072
NPI assigned
Jul 5, 2006
Last updated
Oct 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

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

Authorized official

Name
Miranda Hemm
Title
Enrollment Manager
Phone
(904) 450-6004

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X FL
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Clinical Cardiac Electrophysiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0001X
Clinical Cardiac Electrophysiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0001X FL
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X FL
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X Primary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X FL
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X FL
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X FL
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X FL

Addresses

Primary practice location

2 Shircliff Way
Suite 600
Jacksonville, FL 32204-4742

Mailing address

4500 Salisbury Rd Ste 210
Jacksonville, FL 32216-0968
Phone (904) 308-7959

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20051116000430 FL Part B Supplier - Clinic/Group Practice 2860411188 Receives reassigned benefits from 610 practitioners
O20051129000302 GA Part B Supplier - Clinic/Group Practice 2860411188 Receives reassigned benefits from 61 practitioners
Practice locations: Waycross, GA; Alma, GA; Valdosta, GA; Kingsland, GA; Folkston, GA; Brunswick, GA; Blackshear, GA
O20200827001077 FL MDPP Supplier - in-Person MDPP Supplier 2860411188 Practice locations: Jacksonville, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0721560St Vincents Ambulatory Care Inc Dba2 Shircliff Way Suite 400, Jacksonville, FL 32204Certificate of waiverDec 30, 2026

National Provider Directory

National Provider Directory
Tax ID family
St Vincents Ambulatory Care Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations (25 of 94)

4380 Katella Ave
Los Alamitos, CA 90720

1699 S 14th St
Ste 10
Fernandina Beach, FL 32034
Phone (904) 450-6640

1699 S 14th St
Ste 9
Fernandina Beach, FL 32034
Phone (904) 206-5000

2370 Market Dr
Fleming Island, FL 32003
Phone (904) 264-6201

551616 US Highway 1
Ste 104
Hilliard, FL 32046

10475 Centurion Pkwy N
Ste 3
Jacksonville, FL 32256

10881 San Jose Blvd
#103
Jacksonville, FL 32223

11512 Lake Mead Ave
Unit 521
Jacksonville, FL 32256
Phone (904) 807-9747

1201 Monument Rd
Jacksonville, FL 32225
Phone (904) 727-5151

1750 Stockton St
Ste 101
Jacksonville, FL 32204

1760 Edgewood Ave W
#B
Jacksonville, FL 32208
Phone (904) 358-8480

1760 Edgewood Ave W
Ste A
Jacksonville, FL 32208

1760 Edgewood Ave W
Ste Ab
Jacksonville, FL 32208
Phone (904) 358-8480

2 Shircliff Way
Ste 120
Jacksonville, FL 32204
Phone (904) 619-2006

2 Shircliff Way
Ste 535
Jacksonville, FL 32204

2 Shircliff Way
Ste 625
Jacksonville, FL 32204

2726 Saint Johns Ave
#103104
Jacksonville, FL 32205

2726 Saint Johns Ave
Ste 4
Jacksonville, FL 32205

2771 Monument Rd
Ste 33
Jacksonville, FL 32225
Phone (904) 450-6090

3 Shircliff Way
Ste 100
Jacksonville, FL 32204

3 Shircliff Way
Ste 300
Jacksonville, FL 32204

3 Shircliff Way
Ste 3300
Jacksonville, FL 32204
Phone (904) 384-7370

3 Shircliff Way
Ste 525
Jacksonville, FL 32204
Phone (904) 389-3770

3 Shircliff Way
Ste 526
Jacksonville, FL 32204
Phone (904) 450-6450

3 Shircliff Way
Ste 526527
Jacksonville, FL 32204

Practitioners & affiliated clinicians

Practitioners 692

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 692

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1417987124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 SALISBURY RD STE 210",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322160968",
            "telephone_number": "904-308-7959",
            "fax_number": "904-308-7938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SHIRCLIFF WAY",
            "address_2": "SUITE 600",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044742",
            "telephone_number": "904-308-6769",
            "fax_number": "904-308-4072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST VINCENTS AMBULATORY CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A",
        "authorized_official_last_name": "HEMM",
        "authorized_official_first_name": "MIRANDA",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "904-450-6004"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Oct 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.