Individual provider Active NPI

Jennifer Sally Waldon, PA-C

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1629510599
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9109980 Issued in FL
Practice address
3627 University Blvd S
Suite 615
Jacksonville, FL 32216-4230
Phone
(904) 398-9334
NPI assigned
Nov 9, 2016
Last updated
Jul 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9109980 FL Primary

Addresses

Primary practice location

3627 University Blvd S
Suite 615
Jacksonville, FL 32216-4230

Mailing address

3627 University Blvd S Ste 305
Jacksonville, FL 32216-4294

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170120002613 FL Practitioner - Physician Assistant 5294017588 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

653 W 8TH St
Jacksonville, FL 32209-6511
Phone (904) 244-7874

655 W 8TH St
Jacksonville, FL 32209-6511
Phone (904) 244-7874

655 W 8TH St
Jacksonville, FL 32231-6511
Phone (904) 244-6340

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
59.59 of 100Reported as apm
Quality
59.93
Promoting interoperability
0
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9109980FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians Inc CurrentSince Sep 12, 2022 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Sep 12, 2022 Accepting new patients
University of Florida Jacksonville Physicians, Inc. Past Accepting new patients

Locations

15255 Max Leggett Pkwy
Ste 3100
Jacksonville, FL 32218
Phone (904) 383-1015

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

Interoperability endpoints

  • Direct secure messaging: jwaldon592573@direct.shands.ufl.edu

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1478649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657756800000",
    "number": "1629510599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3627 UNIVERSITY BLVD S STE 305",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3627 UNIVERSITY BLVD S",
            "address_2": "SUITE 615",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164230",
            "telephone_number": "904-398-9334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDON",
        "first_name": "JENNIFER",
        "middle_name": "SALLY",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-09",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.