NPIMap

Organization Active NPI

Ride the Wave Therapy Services

  • Multi-Specialty Clinic/Center
  • St Augustine, FL
National Provider Identifier
1467068023
Registry record updated Sep 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
RIDE THE WAVE THERAPY SERVICES
Practice address
150 Southpark Blvd Ste 202
Saint Augustine, FL 32086-5179
Phone
(904) 217-3103
NPI assigned
Sep 18, 2020
Last updated
Sep 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2020

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

Authorized official

Name
Jana Sanford-HellerNPI 1235743196
Title
Owner
Phone
(352) 256-0658

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

150 Southpark Blvd Ste 202
Saint Augustine, FL 32086-5179

Mailing address

247 Portada Dr
Saint Augustine, FL 32095-1637

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL Fusion Direct

National Provider Directory

National Provider Directory

Locations

150 Southpark Blvd
Ste 202
St Augustine, FL 32086
Phone (904) 217-3103

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1600387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600387200000",
    "number": "1467068023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 PORTADA DR",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320951637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 SOUTHPARK BLVD STE 202",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320865179",
            "telephone_number": "904-217-3103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDE THE WAVE THERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-18",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A",
        "authorized_official_last_name": "SANFORD-HELLER",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-256-0658"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Fusion",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "150 Southpark Blvd Ste 202",
            "city": "Saint Augustine",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320865179",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.