NPIMap

Organization Active NPI

Shands Jacksonville Medical Center Inc

Doing business as Shands Jacksonville Ambulatory Pharmacy

  • Pharmacy
  • Jacksonville, FL
National Provider Identifier
1639267222
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
SHANDS JACKSONVILLE MEDICAL CENTER INC
Doing business as
Shands Jacksonville Ambulatory Pharmacy
Practice address
655 W 8TH St
1St Floor, Acc BLDG.
Jacksonville, FL 32209-6511
Phone
(904) 244-4542
Fax
(904) 244-4998
NPI assigned
Oct 10, 2006
Last updated
Jul 22, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SHANDS JACKSONVILLE MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Authorized official

Name
Mr. Dean Cocchi
Title
Vice President and Cfo of Finance
Phone
(904) 244-5013

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary
Community/Retail Pharmacy 3336C0003X
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

655 W 8TH St
1St Floor, Acc BLDG.
Jacksonville, FL 32209-6511

Mailing address

655 W 8TH St
Jacksonville, FL 32209-6511
Phone (904) 244-8675

Other identifiers 3

IdentifierTypeStateIssuer
0217042-00MedicaidFL
1029164OtherNCPDP
PH16886OtherFLPHARMACY LICENSE NUMBER

Other names 1

  • Shands Jacksonville Ambulatory Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930041539 FL DME Supplier - Pharmacy 2365456258 Practice locations: Jacksonville, FL
O20230831001688 FL Part B Supplier - Pharmacy 2365456258 Practice locations: Jacksonville, FL

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Shands Jacksonville Med Ctr Inc655 W. 8TH St., Jacksonville, FL 32209-6511(904) 244-4020 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since May 2, 2023

National Provider Directory

National Provider Directory
Tax ID family
University Medical Center6 organizations share this tax ID, including this one
Part of
University Medical Center

Other organizations with this tax ID 5

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

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Uf Health Rehabilitation Hospital - NorthJacksonville, FL, CCN 103067 Hospital 5% Or Greater Direct Ownership Interest (49%) Sep 1, 2024
Uf Health Transitional Care-JacksonvilleJacksonville, FL, CCN 105961 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 1999

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721606400000",
    "number": "1639267222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 W 8TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-244-8675",
            "fax_number": "904-244-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W 8TH ST",
            "address_2": "1ST FLOOR, ACC BLDG.",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-244-4542",
            "fax_number": "904-244-4998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANDS JACKSONVILLE MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHANDS JACKSONVILLE MEDICAL CENTER, INC.",
        "enumeration_date": "2006-10-10",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A",
        "authorized_official_last_name": "COCCHI",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "VICE PRESIDENT AND CFO OF FINANCE",
        "authorized_official_telephone_number": "904-244-5013",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0217042-00",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1029164",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE NUMBER",
            "identifier": "PH16886",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shands Jacksonville Ambulatory Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shands Jacksonville Ambulatory Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.