NPIMap

Organization Active NPI

Baptist Primary Care Inc

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1508817529
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BAPTIST PRIMARY CARE INC
Practice address
3563 Philips Hwy Ste 101a
Jacksonville, FL 32207-5663
Phone
(904) 376-3707
Fax
(904) 391-5001
NPI assigned
May 15, 2006
Last updated
Aug 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
Marsha Donaldson
Title
Vice President
Phone
(904) 376-3703

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Family Nurse Practitioner 363LF0000X NU
Family Medicine Physician 207Q00000X FL Primary
Internal Medicine Physician 207R00000X FL
Endocrinology, Diabetes & Metabolism Physician 207RE0101X FL
Infectious Disease Physician 207RI0200X FL
Rheumatology Physician 207RR0500X FL
Pediatrics Physician 208000000X FL
Hospitalist Physician 208M00000X FL

Addresses

Primary practice location

3563 Philips Hwy Ste 101a
Jacksonville, FL 32207-5663

Mailing address

PO Box 746638
Atlanta, GA 30374-6638
Phone (904) 202-2092

Other identifiers 2

IdentifierTypeStateIssuer
265495400MedicaidFL
103895963CMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031217000248 FL Part B Supplier - Clinic/Group Practice 0648177733 Receives reassigned benefits from 567 practitioners
O20080219000243 GA Part B Supplier - Clinic/Group Practice 0648177733 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Saint Marys, GA

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

10898 Baymeadows Rd
Ste 300
Jacksonville, FL 32256
Phone (904) 363-2733

11401 Old Saint Augustine Rd
Jacksonville, FL 32258
Phone (904) 260-1818

820 Prudential Dr
Ste 515
Jacksonville, FL 32207
Phone (904) 396-4886

1577 Roberts Dr
Ste 224
Jacksonville Beach, FL 32250
Phone (904) 246-6940

2349 Village Square Pkwy
Ste 110
Orange Park, FL 32003
Phone (904) 264-6404

141 Hilden Rd
Ste 201
Ponte Vedra, FL 32081
Phone (904) 825-1941

550 Durbin Pavilion Dr
Ste G101
St Johns, FL 32259
Phone (904) 770-2095

2060 Dan Proctor Dr
Ste 3100
Saint Marys, GA 31558
Phone (912) 466-7660

Practitioners & affiliated clinicians

Practitioners 729

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 729

NPI Registry JSON

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1508817529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746638",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746638",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3563 PHILIPS HWY STE 101A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075663",
            "telephone_number": "904-376-3707",
            "fax_number": "904-391-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST PRIMARY CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "DONALDSON",
        "authorized_official_first_name": "MARSHA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "904-376-3703"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265495400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103895963C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Aug 16, 2024; 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.