Organization Active NPI

Origin Diagnostics

  • Occupational Medicine Clinic/Center
  • Jacksonville, FL
National Provider Identifier
1578445821
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
Legal business name
ORIGIN DIAGNOSTICS
Practice address
12574 Flagler Center Blvd Ste 101-63
Jacksonville, FL 32258-2614
Phone
(800) 440-6695
Fax
(323) 203-1648
NPI assigned
Jul 25, 2025
Last updated
Jul 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

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

Authorized official

Name
Brian Drew
Title
VP Innovation
Phone
(317) 502-5695

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Clinic/Center 261QX0100X Primary

Addresses

Primary practice location

12574 Flagler Center Blvd Ste 101-63
Jacksonville, FL 32258-2614

Mailing address

12574 Flagler Center Blvd Ste 101-63
Jacksonville, FL 32258-2614
Phone (800) 440-6695

National Provider Directory

National Provider Directory

Locations

12574 Flagler Center Blvd
Ste 10163
Jacksonville, FL 32258
Phone (800) 440-6695

NPI Registry JSON

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

{
    "created_epoch": "1753401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753401600000",
    "number": "1578445821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12574 FLAGLER CENTER BLVD STE 101-63",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322582614",
            "telephone_number": "800-440-6695",
            "fax_number": "323-203-1648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12574 FLAGLER CENTER BLVD STE 101-63",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322582614",
            "telephone_number": "800-440-6695",
            "fax_number": "323-203-1648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORIGIN DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-25",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A",
        "authorized_official_last_name": "DREW",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "VP INNOVATION",
        "authorized_official_telephone_number": "317-502-5695"
    },
    "taxonomies": [
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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 Jul 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.