NPIMap

Organization Active NPI

Memorial Neurosurgery Group LLC

Doing business as Memorial Neuroscience Center

  • Neurological Surgery Physician
  • Jacksonville, FL
National Provider Identifier
1487860284
Registry record updated Jan 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
MEMORIAL NEUROSURGERY GROUP LLC
Doing business as
Memorial Neuroscience Center
Practice address
3627 University Blvd S
Suite 355
Jacksonville, FL 32216-4230
Phone
(904) 296-2522
Fax
(904) 296-8173
NPI assigned
May 16, 2007
Last updated
Jan 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2008

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

Authorized official

Name
Mickey Pickler
Title
VP
Phone
(850) 523-2117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X Primary

Addresses

Primary practice location

3627 University Blvd S
Suite 355
Jacksonville, FL 32216-4230

Mailing address

3627 University Blvd S
Suite 355
Jacksonville, FL 32216-4230
Phone (904) 296-2522

Other names 1

  • Memorial Neuroscience Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070717000593 FL Part B Supplier - Clinic/Group Practice 9537261185 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
Practice locations: Orange Park, FL; Ocala, FL; Miami, FL; Jacksonville, FL

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

3627 University Blvd S
Ste 355
Jacksonville, FL 32216

3627 University Blvd S
Ste 500
Jacksonville, FL 32216
Phone (904) 399-1623

1825 Kingsley Ave
Ste 170
Orange Park, FL 32073
Phone (904) 272-9981

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200873600000",
    "number": "1487860284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3627 UNIVERSITY BLVD S",
            "address_2": "SUITE 355",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164230",
            "telephone_number": "904-296-2522",
            "fax_number": "904-296-8173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3627 UNIVERSITY BLVD S",
            "address_2": "SUITE 355",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164230",
            "telephone_number": "904-296-2522",
            "fax_number": "904-296-8173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL NEUROSURGERY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2008-01-21",
        "status": "A",
        "authorized_official_last_name": "PICKLER",
        "authorized_official_first_name": "MICKEY",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "850-523-2117"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Neuroscience Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 21, 2008; 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.