Active NPI
John Roger Whittaker, MD
- Urology Physician
- Jacksonville, FL
National Provider Identifier
1457492209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- ME25510
- Practice address
- 710 Lomax St
Jacksonville, FL 32204-4004 - Phone
- (904) 355-6583
- Fax
- (904) 355-4922
- NPI assigned
- Feb 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | ME25510 | FL | Primary |
Addresses
Primary practice location
710 Lomax St
Jacksonville, FL 32204-4004
Mailing address
710 Lomax St
Jacksonville, FL 32204-4004
Phone (904) 355-6583
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 045080400 | Medicaid | FL |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160412001271 | FL | Order and Referring Only - Urology | 4587616412 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME25510 | FL | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210204800000",
"number": "1457492209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 LOMAX ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322044004",
"telephone_number": "904-355-6583",
"fax_number": "904-355-4922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 LOMAX ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322044004",
"telephone_number": "904-355-6583",
"fax_number": "904-355-4922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITTAKER",
"first_name": "JOHN",
"middle_name": "ROGER",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-12",
"last_updated": "2008-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "FL",
"license": "ME25510",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "045080400",
"state": "FL"
}
],
"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 May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.