NPIMap

Organization Active NPI

West Jax Geriatrics, LLC

  • Skilled Nursing Facility
  • Jacksonville, FL
National Provider Identifier
1629439260
Registry record updated Mar 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
ME51340 Issued in FL
Legal business name
WEST JAX GERIATRICS, LLC
Practice address
730 College St
Jacksonville, FL 32204-3313
Phone
(904) 783-9428
Fax
(904) 786-4981
NPI assigned
Mar 10, 2016
Last updated
Mar 11, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2016

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

Authorized official

Name
Dr. Michael Victor Sharpe, M.D.NPI 1750382669
Title
Member
Phone
(904) 783-9428

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X ME51340 FL Primary

Addresses

Primary practice location

730 College St
Jacksonville, FL 32204-3313

Mailing address

100 Cypress Lagoon CT
Ponte Vedra Beach, FL 32082-2106
Phone (904) 783-9428

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161011000449 FL Part B Supplier - Clinic/Group Practice 9537457395 Receives reassigned benefits from 14 practitioners
Practice locations: Hilliard, FL; Jacksonville, FL; Macclenny, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1457568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457654400000",
    "number": "1629439260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CYPRESS LAGOON CT",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320822106",
            "telephone_number": "904-783-9428",
            "fax_number": "904-786-4981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 COLLEGE ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043313",
            "telephone_number": "904-783-9428",
            "fax_number": "904-786-4981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST JAX GERIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-10",
        "last_updated": "2016-03-11",
        "status": "A",
        "authorized_official_last_name": "SHARPE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "VICTOR",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "904-783-9428",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "ME51340",
            "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 Mar 11, 2016; 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.