NPIMap

Organization Active NPI

The Arc of the St Johns, Inc.

  • Community/Behavioral Health Agency
  • St Augustine, FL
National Provider Identifier
1568536274
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
THE ARC OF THE ST JOHNS, INC.
Practice address
2101 Arc Dr
St Augustine, FL 32084-0512
Phone
(904) 824-7249
Fax
(904) 824-8063
NPI assigned
Nov 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

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

Authorized official

Name
Kathy Jackson
Title
Executive Director
Phone
(904) 824-7249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

2101 Arc Dr
St Augustine, FL 32084-0512

Mailing address

2101 Arc Dr
St Augustine, FL 32084-0512
Phone (904) 824-7249

Other identifiers 2

IdentifierTypeStateIssuer
023596296MedicaidFL
029963400MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250424002835 FL Part B Supplier - Clinic/Group Practice 8022534874 Receives reassigned benefits from 4 practitioners
Practice locations: St Augustine, FL

National Provider Directory

National Provider Directory
Tax ID family
The Arc of the St Johns Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748476800000",
    "number": "1568536274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 ARC DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320840512",
            "telephone_number": "904-824-7249",
            "fax_number": "904-824-8063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 ARC DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320840512",
            "telephone_number": "904-824-7249",
            "fax_number": "904-824-8063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE ARC OF THE ST JOHNS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "904-824-7249"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023596296",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029963400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.