NPIMap

Organization Active NPI

Integrated Community Oncology Network LLC

Doing business as Kasraeian Urology Divison of ICON

  • Urology Physician
  • Jacksonville, FL
National Provider Identifier
1649574500
Registry record updated Jun 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC
Doing business as
Kasraeian Urology Divison of ICON
Practice address
6269 Beach Blvd
Suite 2
Jacksonville, FL 32216-2768
Phone
(904) 727-7955
Fax
(904) 727-7976
NPI assigned
Jan 6, 2011
Last updated
Jun 15, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2012

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

Authorized official

Name
Ahmad Kasraeian, MDNPI 1659374320
Title
Kasraeian Urology Division Manager
Phone
(904) 727-7955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

6269 Beach Blvd
Suite 2
Jacksonville, FL 32216-2768

Mailing address

6269 Beach Blvd
Suite 2
Jacksonville, FL 32216-2768
Phone (904) 727-7955

Other identifiers 1

IdentifierTypeStateIssuer
273427300MedicaidFL

Other names 1

  • Kasraeian Urology Divison of ICON Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1294272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339718400000",
    "number": "1649574500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6269 BEACH BLVD",
            "address_2": "SUITE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162768",
            "telephone_number": "904-727-7955",
            "fax_number": "877-406-4796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6269 BEACH BLVD",
            "address_2": "SUITE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162768",
            "telephone_number": "904-727-7955",
            "fax_number": "904-727-7976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-06",
        "last_updated": "2012-06-15",
        "status": "A",
        "authorized_official_last_name": "KASRAEIAN",
        "authorized_official_first_name": "AHMAD",
        "authorized_official_title_or_position": "KASRAEIAN UROLOGY DIVISION MANAGER",
        "authorized_official_telephone_number": "904-727-7955",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273427300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kasraeian Urology Divison of ICON",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.