Lighthouse Internal Medicine and Primary Care PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME92689 Issued in FL

Legal business name

LIGHTHOUSE INTERNAL MEDICINE AND PRIMARY CARE PA

Practice address

5757 Booth Rd.
#200
Jacksonville, FL 32207

Phone

(904) 636-9510

Fax

(904) 636-9512

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Chonglun XieNPI 1861457459

Title

MD

Phone

(904) 636-9510

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

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.

• Chonglun Xie, MD

  • Internal Medicine Physician
  • Jacksonville, FL
  • NPI 1861457459
  Medicare reassignment Care Compare group NPD Authorized official
• Maeve May Madueno, APRN

  • Nurse Practitioner
  • Jacksonville, FL
  • NPI 1235973918
  Medicare reassignment Care Compare group NPD
• Hoi-Kee NG, PA-C

  • Medical Physician Assistant
  • Jacksonville, FL
  • NPI 1083695217
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537488000000",
    "number": "1588742977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5757 BOOTH RD BLDG 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075981",
            "telephone_number": "904-636-9510",
            "fax_number": "904-636-9512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5757 BOOTH RD.",
            "address_2": "#200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32207",
            "telephone_number": "904-636-9510",
            "fax_number": "904-636-9512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE INTERNAL MEDICINE AND PRIMARY CARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2018-09-21",
        "status": "A",
        "authorized_official_last_name": "XIE",
        "authorized_official_first_name": "CHONGLUN",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "904-636-9510"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME92689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009831900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL",
            "identifier": "40311",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273938100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lifestyle Coaching LLC
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• Lifting Individuals and Families for Eternity, Inc
• Valerie Kimberley Ligeon, DDS
• Robert Liggero, PA-C
• Lighthouse Labs LLC
• Orion Lightly, CRPS
• Jharman Lightner, M.S.,ITDS
• Rishyah Lightner
• D'Shantis Ray'Ana Lightsey

• Internal Medicine Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2018; 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.