NPIMap

Individual provider Active NPI

Ammala Cantrell

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1639159684
Registry record updated Apr 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME84833 Issued in FL
Practice address
11512 Lake Mead Ave Unit 302
Jacksonville, FL 32256-9685
Phone
(904) 900-3472
Fax
(904) 503-2373
NPI assigned
Jan 18, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME84833 FL Primary

Addresses

Primary practice location

11512 Lake Mead Ave Unit 302
Jacksonville, FL 32256-9685

Mailing address

PO Box 50670
Jacksonville Beach, FL 32240-0670
Phone (904) 673-5553

Other identifiers 2

IdentifierTypeStateIssuer
62087AOtherFLFLORIDA BLUE SHIELD
ME84833OtherFLLICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050909000545 FL Practitioner - Family Practice 5799717930 Practice locations: Jacksonville, FL; Ponte Verda Beach, FL; Jacksonville Beach, FL

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1504 Seabreeze Ave
Jacksonville Beach, FL 32250-3365
Phone (904) 249-7421

Hospital & facility affiliations

  • Confident Care of Florida Corp Home health agency, Jacksonville, FL, CCN 108371
  • Concierge Home Care Home health agency, Jacksonville, FL, CCN 109742
  • Community Hospice of Northeast Florida Inc Hospice, Jacksonville, FL, CCN 101500
  • Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545
  • Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001
  • Baptist Medical Center Beaches Hospital, Jacksonville Beach, FL, CCN 100117
  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • Terrace of Jacksonville, the Nursing home, Jacksonville, FL, CCN 105423
  • Woodland Grove Healthcare & Rehabilitation Center Nursing home, Jacksonville, FL, CCN 106058
  • Westside Oaks Rehabilitation & Nursing Center Nursing home, Jacksonville, FL, CCN 105287

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME84833FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Symphony Specialty Group, LLC PastSince Jul 17, 2023 Accepting new patients
Cantrell Cornerstone Clinic, LLC Family Medicine PastSince Jul 24, 2022 Accepting new patients
Skilled Nursing Infectious Disease LLC PastSince Aug 15, 2023 Accepting new patients
Jacksonville Hospitalists PA PastSince Feb 1, 2001 Accepting new patients
Cornerstone Family Medicine LLC Family Medicine Past Accepting new patients
On Site Dermatology LLC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10036363

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Terrace of JacksonvilleJacksonville, FL, CCN 105423 Skilled nursing facility Adp of the SNF Apr 1, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523232000000",
    "number": "1639159684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50670",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322400670",
            "telephone_number": "904-673-5553",
            "fax_number": "904-641-1017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE UNIT 302",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569685",
            "telephone_number": "904-900-3472",
            "fax_number": "904-503-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANTRELL",
        "first_name": "AMMALA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-18",
        "last_updated": "2018-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME84833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE SHIELD",
            "identifier": "62087A",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "ME84833",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.