NPIMap

Organization Active NPI

Monogram Health Professional Services of Florida LLC

  • Nephrology Physician
  • Jacksonville, FL
National Provider Identifier
1538883111
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
MONOGRAM HEALTH PROFESSIONAL SERVICES OF FLORIDA LLC
Practice address
4720 Salisbury Rd
Jacksonville, FL 32256-6101
Phone
(615) 673-4455
Fax
(615) 432-4651
NPI assigned
Sep 28, 2022
Last updated
Jan 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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

Authorized official

Name
Shawn L Verner
Title
Secretary
Phone
(615) 994-1889

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X
Specialist 174400000X
Family Medicine Physician 207Q00000X
Cardiovascular Disease Physician 207RC0000X
Endocrinology, Diabetes & Metabolism Physician 207RE0101X
Nephrology Physician 207RN0300X Primary
Pulmonary Disease Physician 207RP1001X
Psychiatry Physician 2084P0800X
General Practice Physician 208D00000X
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Family Nurse Practitioner 363LF0000X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Advanced Heart Failure and Transplant Cardiology Physician 207RA0001X
Cardiology Pharmacist 1835C0206X

Addresses

Primary practice location

4720 Salisbury Rd
Jacksonville, FL 32256-6101

Mailing address

5410 Maryland Way Ste 400
Brentwood, TN 37027-8087
Phone (615) 465-8684

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221128001413 FL Part B Supplier - Clinic/Group Practice 0244608149 Receives reassigned benefits from 94 practitioners
Practice locations: Jacksonville, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2309929Monogram Health Professional4720 Salisbury Road, Jacksonville, FL 32256Certificate of waiverAug 22, 2026
10D2317230Monogram Health Professional Services4720 Salisbury Road, Jacksonville, FL 32256Certificate of waiverJan 20, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 94

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 94

NPI Registry JSON

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

{
    "created_epoch": "1664323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738108800000",
    "number": "1538883111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5410 MARYLAND WAY STE 400",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370278087",
            "telephone_number": "615-465-8684",
            "fax_number": "629-240-6003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4720 SALISBURY RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566101",
            "telephone_number": "615-673-4455",
            "fax_number": "615-432-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONOGRAM HEALTH PROFESSIONAL SERVICES OF FLORIDA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-28",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A",
        "authorized_official_last_name": "VERNER",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-994-1889"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Advanced Heart Failure and Transplant Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1835C0206X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Jan 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.