St Vincents Physician Enterprise Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

ST VINCENTS PHYSICIAN ENTERPRISE INC

Practice address

2627 Riverside Ave
Jacksonville, FL 32204-4712

Phone

(904) 308-7372

Fax

(904) 308-6909

NPI assigned

Apr 1, 2010

Organization subpart

Yes

Parent organization

ST VINCENTS PRIMARY CAREAs reported in NPPES

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

Authorized official

Name

Gene Miyamoto

Title

System Coo

Phone

(904) 308-1290

Specialties & licenses 1

Addresses

Other names 1

• St Vincents Primary Care Doing business as

Part of

Margaret H Duffy MD

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samantha Cribbett, NP

  • Nurse Practitioner
  • Jacksonville, FL
  • NPI 1871616003
  NPD (past)
• Richard Kenneth Peterson, M.D.

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1508858861
  NPD (past)
• Melinda Jimenez, PA-C

  • Physician Assistant
  • New York, NY
  • NPI 1588934814
  NPD (past)

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

{
    "created_epoch": "1270080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283385600000",
    "number": "1477878486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2627 RIVERSIDE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044712",
            "telephone_number": "904-308-7372",
            "fax_number": "904-308-6909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 RIVERSIDE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044712",
            "telephone_number": "904-308-7372",
            "fax_number": "904-308-6909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST VINCENTS PHYSICIAN ENTERPRISE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST VINCENTS PRIMARY CARE",
        "enumeration_date": "2010-04-01",
        "last_updated": "2010-09-02",
        "status": "A",
        "authorized_official_last_name": "MIYAMOTO",
        "authorized_official_first_name": "GENE",
        "authorized_official_title_or_position": "SYSTEM COO",
        "authorized_official_telephone_number": "904-308-1290"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Vincents Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St Vincents Electrocardiography, Inc
• St Vincents Medical Center Inc
• St Vincents Medical Center Inc
• St Vincents Medical Center Inc
• St Vincents Pathology Associates PA
• Matthew Tyler St. George, RD
• Teresa Marie St. John, PT
• St. John'S Integrated Health, Inc.
• St. Johns Bluff Family Practice
• St. Johns Interventional and Vascular Institute

• All providers in Jacksonville, FL
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2010; 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.