NPIMap

Organization Active NPI

Memorial Family Practice Associates, LLC

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1598869844
Registry record updated Apr 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEMORIAL FAMILY PRACTICE ASSOCIATES, LLC
Practice address
1731 University Blvd S
Jacksonville, FL 32216-8928
Phone
(904) 725-0200
Fax
(904) 721-5711
NPI assigned
Sep 8, 2006
Last updated
Apr 10, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL FAMILY PRACTICE ASSOCIATES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 10, 2023

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

Authorized official

Name
Robert A Faile III
Title
Vice President
Phone
(843) 956-7923

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X ME0010521 FL
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1731 University Blvd S
Jacksonville, FL 32216-8928

Mailing address

1731 University Blvd S
Jacksonville, FL 32216-8928
Phone (904) 725-0200

Other names 1

  • Memorial Family Practice Associates Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060220000077 FL Part B Supplier - Clinic/Group Practice 8820003411 Receives reassigned benefits from 62 practitioners
O20180424002347 GA Part B Supplier - Clinic/Group Practice 8820003411 Receives reassigned benefits from 2 practitioners
Practice locations: Waycross, GA

National Provider Directory

National Provider Directory
Tax ID family
Memorial Advanced Surgery8 organizations share this tax ID, including this one
Part of
Memorial Advanced Surgery

Other organizations with this tax ID 7

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

Locations

14810 Old St Augustine Rd
Ste 101
Jacksonville, FL 32258
Phone (904) 292-4111

1731 University Blvd S
Jacksonville, FL 32216
Phone (904) 725-0200

2689 Art Museum Dr
Jacksonville, FL 32207
Phone (904) 264-2006

2731 Park St
Jacksonville, FL 32205
Phone (904) 346-0050

3627 University Blvd S
Ste 210
Jacksonville, FL 32216
Phone (904) 399-5311

3627 University Blvd S
Ste 425
Jacksonville, FL 32216
Phone (904) 346-0086

3627 University Blvd S
Ste 500
Jacksonville, FL 32216
Phone (904) 396-2804

3627 University Blvd S
Ste 700
Jacksonville, FL 32216

3627 University Blvd S
Ste 710
Jacksonville, FL 32216
Phone (904) 264-2006

6817 Southpoint Pkwy
Ste 1703
Jacksonville, FL 32216
Phone (904) 330-0466

7807 Baymeadows Rd E
Ste 200
Jacksonville, FL 32256
Phone (904) 398-4133

2755 Blanding Blvd
Ste 109
Middleburg, FL 32068
Phone (904) 282-2577

1670 Eagle Harbor Pkwy
Ste B
Orange Park, FL 32003
Phone (904) 541-3048

1825 Kingsley Ave
Ste 200
Orange Park, FL 32073
Phone (904) 264-8621

1825 Kingsley Ave
Ste 250
Orange Park, FL 32073
Phone (904) 276-2549

1883 Kingsley Ave
#3
Orange Park, FL 32073
Phone (904) 777-2667

1895 Kingsley Ave
Ste 404
Orange Park, FL 32073
Phone (904) 276-9683

2021 Kingsley Ave
Ste 100
Orange Park, FL 32073
Phone (904) 639-2000

2021 Professional Center Dr
Ste 101
Orange Park, FL 32073
Phone (904) 213-9210

4689 US Highway 17
Ste 11
Orange Park, FL 32003
Phone (904) 375-9753

2601 Blairstone Rd
Tallahassee, FL 32399

1908 Alice St
Waycross, GA 31501
Phone (912) 338-6010

Practitioners & affiliated clinicians

Practitioners 118

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 118

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681084800000",
    "number": "1598869844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1731 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168928",
            "telephone_number": "904-725-0200",
            "fax_number": "904-721-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1731 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168928",
            "telephone_number": "904-725-0200",
            "fax_number": "904-721-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL FAMILY PRACTICE ASSOCIATES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL FAMILY PRACTICE ASSOCIATES, LLC",
        "enumeration_date": "2006-09-08",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A",
        "authorized_official_last_name": "FAILE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "843-956-7923",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0010521",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Family Practice Associates",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Memorial Family Practice Associates",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Apr 10, 2023; 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.