NPIMap

Organization Active NPI

Caremax Clinic 711 LLC

  • Internal Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1609359249
Registry record updated Dec 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CAREMAX CLINIC 711 LLC
Practice address
2732 Trollie LN
Jacksonville, FL 32211-3833
Phone
(904) 289-1254
Fax
(904) 212-0036
NPI assigned
Sep 10, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2025

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

Authorized official

Name
Vipul B MamtoraNPI 1902929565
Title
Director
Phone
(904) 289-1254

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X

Addresses

Primary practice location

2732 Trollie LN
Jacksonville, FL 32211-3833

Mailing address

PO Box 600365
Jacksonville, FL 32260-0365
Phone (904) 289-1254

Other practice location 1

2789 Park St
Jacksonville, FL 32205-7607
Phone (904) 289-1254

Other names 1

  • ValueCare Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190523000156 FL Part B Supplier - Clinic/Group Practice 3577806173 Receives reassigned benefits from 12 practitioners
Practice locations: Jacksonville, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2263685Caremax Clinic 711 LLC2732 Trollie Lane, Jacksonville, FL 32211Certificate of waiverJun 30, 2028

National Provider Directory

National Provider Directory

Locations

2789 Park St
Jacksonville, FL 32205
Phone (904) 289-1254

2732 Trollie Ln
Jacksonville, FL 32211
Phone (904) 289-1254

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765756800000",
    "number": "1609359249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 600365",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322600365",
            "telephone_number": "904-289-1254",
            "fax_number": "904-202-0036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2732 TROLLIE LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322113833",
            "telephone_number": "904-289-1254",
            "fax_number": "904-212-0036"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2789 Park St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322057607",
            "country_code": "US",
            "telephone_number": "904-289-1254",
            "fax_number": "904-212-0036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAREMAX CLINIC 711 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-10",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A",
        "authorized_official_last_name": "MAMTORA",
        "authorized_official_first_name": "VIPUL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "904-289-1254"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ValueCare Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.