Individual provider Active NPI

Chamonix Kinimaka, MD

  • Family Medicine Physician
  • Orange Park, FL
National Provider Identifier
1649664657
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME132002 Issued in FL
Practice address
2001 Kingsley Ave
Orange Park, FL 32073
Phone
(904) 639-2000
Fax
(904) 639-2015
NPI assigned
Mar 27, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 262217 NY
Family Medicine Physician 207Q00000X ME132002 FL Primary

Addresses

Primary practice location

2001 Kingsley Ave
Orange Park, FL 32073

Mailing address

23343 NW County Road 236
High Springs, FL 32643-9669
Phone (904) 639-2000

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180809004568 FL Practitioner - Family Practice 1456640697 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inpatient Consultants of Florida, IncGroup PAC ID 4789614785, 158 clinicians

Practice addresses (Care Compare)

2001 Kingsley Ave
Orange Park, FL 32073-5148
Phone (904) 276-8500

Hospital & facility affiliations

  • Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545
  • HCA Florida Orange Park Hospital Hospital, Orange Park, FL, CCN 100226
  • HCA FL Orange Park Hospital Rehabilitation Center Inpatient rehabilitation facility, Orange Park, FL, CCN 10T226

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
262217NYMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Inpatient Consultants of Florida Inc CurrentSince Nov 26, 2019 Accepting new patients
Inpatient Consultants of Florida, Inc CurrentSince Nov 26, 2019 Accepting new patients
Inpatient Consultants of Florida, Inc Current Accepting new patients

Locations

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

6000 49th St N
St Petersburg, FL 33709
Phone (727) 521-4411

3030 W Bearss Ave
Tampa, FL 33618
Phone (813) 932-2222

Organizations & group practices 3

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 6

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": "1427414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1649664657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23343 NW COUNTY ROAD 236",
            "city": "HIGH SPRINGS",
            "state": "FL",
            "postal_code": "326439669",
            "telephone_number": "904-639-2000",
            "fax_number": "904-639-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 KINGSLEY AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "32073",
            "telephone_number": "904-639-2000",
            "fax_number": "904-639-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINIMAKA",
        "first_name": "CHAMONIX",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-27",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "262217",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME132002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.