Active NPI
Baptist Primary Care Inc
- Rheumatology Physician
- Jacksonville, FL
National Provider Identifier
1639351927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- Legal business name
- BAPTIST PRIMARY CARE INC
- Practice address
- 1660 Prudential Dr Ste 310
Jacksonville, FL 32207-8185 - Phone
- (904) 396-8656
- Fax
- (904) 396-8621
- NPI assigned
- Nov 29, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Marsha Donaldson
- Title
- Vice President
- Phone
- (904) 376-3703
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | Primary |
Addresses
Primary practice location
1660 Prudential Dr Ste 310
Jacksonville, FL 32207-8185
Mailing address
PO Box 45443
Salt Lake City, UT 84145-0443
Phone (904) 202-1032
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 265495400 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031217000248 | FL | Part B Supplier - Clinic/Group Practice | 0648177733 |
Receives reassigned benefits from 567 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196294400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1599177600000",
"number": "1639351927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 45443",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841450443",
"telephone_number": "904-202-1032",
"fax_number": "904-376-4107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1660 PRUDENTIAL DR STE 310",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322078185",
"telephone_number": "904-396-8656",
"fax_number": "904-396-8621"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BAPTIST PRIMARY CARE INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-11-29",
"last_updated": "2020-09-04",
"certification_date": "2020-09-04",
"status": "A",
"authorized_official_last_name": "DONALDSON",
"authorized_official_first_name": "MARSHA",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "904-376-3703"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Rheumatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "265495400",
"state": "FL"
}
],
"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 Sep 4, 2020; 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.