Individual provider Active NPI

Michele St Martin Hargreaves, MD

  • Otolaryngology Physician
  • Jacksonville, FL
National Provider Identifier
1457326472
Registry record updated Nov 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
ME98473 Issued in FL
Practice address
4203 Belfort Rd
Ste 340
Jacksonville, FL 32216-1409
Phone
(904) 880-0911
Fax
(904) 880-9388
NPI assigned
Feb 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MD425320 PA
Otolaryngology Physician 207Y00000X ME98473 FL Primary
Otology & Neurotology Physician 207YX0901X ME98473 FL

Addresses

Primary practice location

4203 Belfort Rd
Ste 340
Jacksonville, FL 32216-1409

Mailing address

11945 San Jose Blvd
Suite 300
Jacksonville, FL 32223-1613
Phone (904) 396-1725

Other identifiers 1

IdentifierTypeStateIssuer
278642700MedicaidFL

Other names 1

  • Michele Bauchet St Martin Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070907000401 FL Practitioner - Otolaryngology 8628014438 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME98473FLMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Florida Surgeons, PA CurrentSince Sep 1, 2014 Accepting new patients
North Florida Surgeons, PA CurrentSince Sep 1, 2014 Accepting new patients

Locations

11945 San Jose Blvd
Ste 300
Jacksonville, FL 32223

11945 San Jose Blvd
Ste 102
Jacksonville, FL 32223
Phone (904) 268-3937

4203 Belfort Rd
Ste 340
Jacksonville, FL 32216
Phone (904) 880-0911

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478476800000",
    "number": "1457326472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11945 SAN JOSE BLVD",
            "address_2": "SUITE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322231613",
            "telephone_number": "904-396-1725",
            "fax_number": "904-399-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4203 BELFORT RD",
            "address_2": "STE 340",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161409",
            "telephone_number": "904-880-0911",
            "fax_number": "904-880-9388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARGREAVES",
        "first_name": "MICHELE",
        "middle_name": "ST MARTIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-22",
        "last_updated": "2016-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD425320",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": "ME98473",
            "primary": true
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "FL",
            "license": "ME98473",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278642700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELE",
            "last_name": "ST MARTIN",
            "middle_name": "BAUCHET",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.