Individual provider Active NPI

Gloria Koo Reid, NP

  • Acute Care Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1487824728
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
R168950 Issued in MD
Practice address
4205 Belfort Rd Ste 2069
Jacksonville, FL 32216-1471
Phone
(904) 450-8500
NPI assigned
Mar 3, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X R168950 MD Primary

Addresses

Primary practice location

4205 Belfort Rd Ste 2069
Jacksonville, FL 32216-1471

Mailing address

4205 Belfort Rd Ste 2069
Jacksonville, FL 32216-1471
Phone (904) 450-8500

Other practice location 1

Ichp 8901 Wisconsin Ave
Building 17, Suite 2A
Bethesda, MD 20889-5600
Phone (301) 400-1111 ext. 1115

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250204002985 FL Practitioner - Nurse Practitioner 8729205927 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Vincent'S Ambulatory Care IncGroup PAC ID 2860411188, 303 clinicians

Practice addresses (Care Compare)

1801 Barrs St
Suite 120
Jacksonville, FL 32204-4738
Phone (904) 308-2006

4205 Belfort Rd
Jacksonville, FL 32216-1471
Phone (904) 296-0278

Hospital & facility affiliations

  • Ascension St Vincent'S Southside Hospital, Jacksonville, FL, CCN 100307
  • Ascension St Vincent'S Riverside Hospital, Jacksonville, FL, CCN 100040
  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Ambulatory Care Inc CurrentSince Feb 3, 2025 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Feb 3, 2025 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

4205 Belfort Rd
Ste 2069
Jacksonville, FL 32216
Phone (904) 296-0278

Interoperability endpoints

  • Direct secure messaging: gloria.reid.1@8967.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1204502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1487824728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 2069",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161471",
            "telephone_number": "904-450-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 2069",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161471",
            "telephone_number": "904-450-8500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Ichp 8901 Wisconsin Ave",
            "address_2": "Building 17, Suite 2A",
            "address_purpose": "LOCATION",
            "city": "Bethesda",
            "state": "MD",
            "postal_code": "208895600",
            "country_code": "US",
            "telephone_number": "301-400-1111 x1115",
            "fax_number": "301-400-1620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REID",
        "first_name": "GLORIA",
        "middle_name": "KOO",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-03",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MD",
            "license": "R168950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.