Individual provider Active NPI

Kadijo Wade-Thomas, MD

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1558711689
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME138582 Issued in FL
Practice address
1833 Boulevard
Jacksonville, FL 32206-4382
Phone
(904) 383-1040
NPI assigned
Jun 20, 2016
Last updated
Sep 15, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TRN 23166 FL
Family Medicine Physician 207Q00000X ME138582 FL Primary

Addresses

Primary practice location

1833 Boulevard
Jacksonville, FL 32206-4382

Mailing address

1833 Boulevard
Pob 5TH Floor
Jacksonville, FL 32206
Phone (904) 244-0350

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191009003536 FL Practitioner - Family Practice 4789963562 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Florida State University College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Florida Jacksonville Physicians, Inc.Group PAC ID 9133025869, shared by 5 NPIs, 908 clinicians

Practice addresses (Care Compare)

1255 Lila St
Jacksonville, FL 32208-3550

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
59.59 of 100Reported as apm
Quality
59.93
Promoting interoperability
0
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians, Inc. Family Medicine CurrentSince Mar 1, 2021 Accepting new patients
University of Florida Jacksonville Physicians Inc Current Accepting new patients
University of Florida Jacksonville Physicians Inc Family Medicine CurrentSince Sep 9, 2019 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Sep 9, 2019 Accepting new patients
University of Florida Jacksonville Physicians, Inc. Family Medicine Past Accepting new patients

Locations

1255 Lila St
Jacksonville, FL 32208
Phone (904) 244-5700

1833 Boulevard
Jacksonville, FL 32206
Phone (904) 244-3289

1833 Boulevard
Fl 5
Jacksonville, FL 32206
Phone (904) 383-1040

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

Interoperability endpoints

  • Direct secure messaging: kwade439991@direct.shands.ufl.edu

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1558711689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1833 BOULEVARD",
            "address_2": "POB 5TH FLOOR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32206",
            "telephone_number": "904-244-0350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1833 BOULEVARD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322064382",
            "telephone_number": "904-383-1040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE-THOMAS",
        "first_name": "KADIJO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-20",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "TRN 23166",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME138582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.