St Vincents Ambulatory Care Inc
Organization Active NPI Neurological Surgery Physician · Jacksonville, FL
NPI 1417987124 · NPPES record last updated Oct 17, 2022
Key facts
- NPI
- 1417987124
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Neurological Surgery Physician 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
- Organization subpart
- No
Authorized official
- Name
- Miranda Hemm
- Title
- Enrollment Manager
- Phone
- (904) 450-6004
Corporate family (same tax ID) 3
Practitioners 695
-
Hanie Fawzy Abdel Masih, D.O.
-
Malhar Agarwal, MD
-
Cesar Ian Aguirre, M.D.
-
Abdulaziz H Alburaih, M.D
-
Phillip Daniel Alix, PA-C
-
Subashini Anand, M.D.
-
Tina Michelle Anderson, APRN
-
Alex M Arce, D.O.
-
Jessica Lynn Askew, DNP
-
Ravi Prasad Avati Nanjundappa, MD, MPH
-
Jason John Bailey, APRN
-
Angela Baker, ARNP
-
Zain Barnouti, DPM
-
Heather Pauline Bennett, ARPN-C
-
Harish Bhaskar, MD
-
Nicole Bikowitz, FNP-C
-
Mary Blade, ARNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D0721560 | St Vincents Ambulatory Care Inc Dba | Certificate of waiver | Dec 30, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in FL, GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- St Vincents Ambulatory Care Inc
Locations (25 of 97)
4380 Katella Ave
Los Alamitos, CA 90720
2853 Henley Rd
Ste 104
Green Cove Springs, FL 32043
Phone (904) 602-4330
2853 Henley Rd
Ste 103
Green Cove Springs, FL 32043
Phone (904) 602-4510
705 Ferris St
Green Cv Spgs, FL 32043
Phone (904) 284-4510
551616 US Highway 1
Ste 104
Hilliard, FL 32046
1201 Monument Rd
Jacksonville, FL 32225
Phone (904) 727-5151
2332 Riverside Ave
Jacksonville, FL 32204
Phone (904) 388-2540
864 Monument Rd Ste a
Jacksonville, FL 32225
4500 Salisbury Rd
Ste 210
Jacksonville, FL 32216
2726 Saint Johns Ave
#103104
Jacksonville, FL 32205
4745 Sutton Park Ct
Jacksonville, FL 32224
3 Shircliff Way
Ste 700
Jacksonville, FL 32204
Phone (904) 398-2756
2726 Saint Johns Ave
Ste 104
Jacksonville, FL 32205
Phone (904) 450-8940
3 Shircliff Way
Ste 710
Jacksonville, FL 32204
Phone (904) 308-1180
4035 Southpoint Blvd
Jacksonville, FL 32216
Phone (833) 894-4420
858 Monument Rd
Ste A
Jacksonville, FL 32225
Phone (904) 450-6600
4201 Belfort Rd
Ste 302
Jacksonville, FL 32216
6858 103rd St
Jacksonville, FL 32210
2 Shircliff Way
Ste 400
Jacksonville, FL 32204
Phone (904) 308-4000
4203 Belfort Rd
Ste 335
Jacksonville, FL 32216
Phone (904) 296-5688
3 Shircliff Way
Ste 526527
Jacksonville, FL 32204
4203 Belfort Rd
Ste 250
Jacksonville, FL 32216
Phone (904) 308-3751
2 Shircliff Way
Ste 625
Jacksonville, FL 32204
4203 Belfort Rd
Ste 204
Jacksonville, FL 32216
Phone (904) 296-5688
2771 Monument Rd
Ste 33
Jacksonville, FL 32225
Phone (904) 450-6090
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | FL | ||
| Cardiovascular Disease Physician |
207RC0000X | |||
| Clinical Cardiac Electrophysiology Physician |
207RC0001X | |||
| Clinical Cardiac Electrophysiology Physician |
207RC0001X | FL | ||
| Pulmonary Disease Physician |
207RP1001X | FL | ||
| Neurological Surgery Physician |
207T00000X | Yes | ||
| Neurological Surgery Physician |
207T00000X | FL | ||
| Obstetrics & Gynecology Physician |
207V00000X | FL | ||
| Surgery Physician |
208600000X | FL | ||
| Vascular Surgery Physician |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 276587000 | Medicaid | FL |
Other providers in Jacksonville, FL
- St Vincent'S Full Service Urgent Care, LLC
- St Vincent'S Full Service Urgent Care, LLC
- St Vincent'S Full Service Urgent Care, LLC
- St Vincent'S Full Service Urgent Care, LLC
- St Vincent'S Full Service Urgent Care, LLC
- St Vincents Ambulatory Care Inc
- St Vincents Electrocardiography, Inc
- St Vincents Medical Center Inc
- St Vincents Medical Center Inc
- St Vincents Medical Center Inc
All providers in Jacksonville, FL · Neurological Surgery Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.