NPIMap

Organization Active NPI

St Vincents Medical Center Inc

Doing business as St Vincents Family Medicine Center

  • Primary Care Clinic/Center
  • Jacksonville, FL
National Provider Identifier
1427005131
Registry record updated Mar 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ST VINCENTS MEDICAL CENTER INC
Doing business as
St Vincents Family Medicine Center
Practice address
2627 Riverside Ave
Jacksonville, FL 32204-4712
Phone
(904) 308-7372
NPI assigned
May 28, 2006
Last updated
Mar 26, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
ST VINCENTS MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 26, 2010

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

Authorized official

Name
Gene Miyamoto
Title
Coo
Phone
(904) 308-1290

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

2627 Riverside Ave
Jacksonville, FL 32204-4712

Mailing address

2627 Riverside Ave
Jacksonville, FL 32204-4712
Phone (904) 308-7372

Other names 1

  • St Vincents Family Medicine Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031119000296 FL Part B Supplier - Clinic/Group Practice 0244144558 Receives reassigned benefits from 37 practitioners
Practice locations: Jacksonville, FL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
John a Shannon MD3 organizations share this tax ID, including this one
Part of
John a Shannon MD

Other organizations with this tax ID 2

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

Member of 1

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

Locations

1 Shircliff Way
Jacksonville, FL 32204
Phone (904) 332-0414

2708 Saint Johns Ave
Jacksonville, FL 32205
Phone (904) 308-7372

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269561600000",
    "number": "1427005131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2627 RIVERSIDE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044712",
            "telephone_number": "904-308-7372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 RIVERSIDE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044712",
            "telephone_number": "904-308-7372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST VINCENTS MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST VINCENTS MEDICAL CENTER INC",
        "enumeration_date": "2006-05-28",
        "last_updated": "2010-03-26",
        "status": "A",
        "authorized_official_last_name": "MIYAMOTO",
        "authorized_official_first_name": "GENE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "904-308-1290"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Vincents Family Medicine Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 26, 2010; 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.