Jeremy Caudill DO

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

OS10861 Issued in FL

Legal business name

JEREMY CAUDILL DO

Practice address

2460 Old Moultrie Rd Ste 3
St Augustine, FL 32086-4198

Phone

(904) 797-6627

Fax

(888) 640-9997

NPI assigned

Apr 21, 2017

Last updated

Jun 1, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeremy Alan Caudill, D.O.,NPI 1265650295

Title

President

Phone

(904) 797-6627

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 2

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.

• Jeremy Alan Caudill, D.O.

  • Surgery Physician
  • St Augustine, FL
  • NPI 1265650295
  Medicare reassignment NPD Authorized official
• Wendy Lantz, APRN

  • Family Nurse Practitioner
  • St Augustine, FL
  • NPI 1093466526
  NPD (past)

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

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496275200000",
    "number": "1437684032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 OLD MOULTRIE RD STE 3",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864198",
            "telephone_number": "904-797-6627",
            "fax_number": "888-640-9997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 OLD MOULTRIE RD STE 3",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864198",
            "telephone_number": "904-797-6627",
            "fax_number": "888-640-9997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEREMY CAUDILL DO",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-21",
        "last_updated": "2017-06-01",
        "status": "A",
        "authorized_official_last_name": "CAUDILL",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-797-6627",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O.,"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "OS10861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "OS10861",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara Jenkin, MA,CAP
• Allison Jenkins
• James Louis Jenkins, LMHC
• Katherine M Jennison, RD LDN
• Jeremiah D Gordon, DMD, PA (Gordon Dental Associates)
• Audrey Lee Jernigan, LMT
• George Alton Jernigan III
• Felicia Ann Jerome, D.O.
• Nathan Jimmerson, PTA
• Natasha Jno Baptiste

• Surgery Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2017; 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.