NPIMap

Organization Active NPI

Podiatry Associates of Florida Inc

  • Podiatrist
  • Jacksonville, FL
National Provider Identifier
1477749604
Registry record updated Sep 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
PODIATRY ASSOCIATES OF FLORIDA INC
Practice address
953 Lane Ave S
Jacksonville, FL 32205-4706
Phone
(904) 695-4447
Fax
(904) 771-2002
NPI assigned
Sep 21, 2007
Last updated
Sep 3, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2009

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

Authorized official

Name
Susan G Sinchuk
Title
Business Administrator
Phone
(904) 224-2001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X NU Primary

Addresses

Primary practice location

953 Lane Ave S
Jacksonville, FL 32205-4706

Mailing address

3117 Spring Glen Rd
Ste 402
Jacksonville, FL 32207-5906
Phone (904) 224-2001

Other identifiers 5

IdentifierTypeStateIssuer
CJ5902OtherRAILROAD MEDICARE
87931OtherBLUE CROSS BLUE SHIELD
480028951OtherRAILROAD MEDICARE
CI4974OtherRAILROAD MEDICARE
480033097OtherRAILROAD MEDICARE

Other names 1

  • Podiatry Associates of Northeast Florida Inc Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050324000347 FL Part B Supplier - Clinic/Group Practice 8820044688 Receives reassigned benefits from 16 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jacksonville, FL; Orange Park, FL; Jacksonville Beach, FL; Clearwater, FL

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory

Locations

6983 103rd St
#4974
Jacksonville, FL 32210

953 Lane Ave S
Jacksonville, FL 32205
Phone (904) 695-4447

NPI Registry JSON

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

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251936000000",
    "number": "1477749604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3117 SPRING GLEN RD",
            "address_2": "STE 402",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075906",
            "telephone_number": "904-224-2001",
            "fax_number": "904-224-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "953 LANE AVE S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322054706",
            "telephone_number": "904-695-4447",
            "fax_number": "904-771-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PODIATRY ASSOCIATES OF FLORIDA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-21",
        "last_updated": "2009-09-03",
        "status": "A",
        "authorized_official_last_name": "SINCHUK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "904-224-2001"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CJ5902",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "87931",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480028951",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI4974",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480033097",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Podiatry Associates of Northeast Florida Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Sep 3, 2009; 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.