NPIMap

Individual provider Active NPI

Ahmad Kasraeian, M.D.

  • Urology Physician
  • Jacksonville, FL
National Provider Identifier
1659374320
Registry record updated Aug 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
FLME 0029693 Issued in FL
Practice address
6269 Beach Blvd
Ste 2
Jacksonville, FL 32216-2705
Phone
(904) 727-7955
Fax
(904) 727-7976
NPI assigned
May 24, 2005
Reactivated
Mar 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X FLME 0029693 FL Primary

Addresses

Primary practice location

6269 Beach Blvd
Ste 2
Jacksonville, FL 32216-2705

Mailing address

6269 Beach Blvd
Ste 2
Jacksonville, FL 32216-2705
Phone (904) 727-7955

Other identifiers 1

IdentifierTypeStateIssuer
043722100MedicaidFL

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
I20050720000311 FL Practitioner - Urology 7214964469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1970
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6269 Beach Blvd
Suite 2
Jacksonville, FL 32216-2769
Phone (904) 727-7955

Hospital & facility affiliations

  • Baptist Medical Center Beaches Hospital, Jacksonville Beach, FL, CCN 100117
  • HCA Florida Memorial Hospital Hospital, Jacksonville, FL, CCN 100179
  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001
  • Flagler Hospital Hospital, Saint Augustine, FL, CCN 100090

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
FLME 0029693FLMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Physician Specialists LLC Urology CurrentSince Jan 1, 2013 Accepting new patients
Florida Physician Specialists LLC Current Accepting new patients
Florida Physician Specialists LLC CurrentSince Jan 1, 2013 Accepting new patients

Locations

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

710 Lomax St
Jacksonville, FL 32204
Phone (904) 355-6584

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 7

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": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343865600000",
    "number": "1659374320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6269 BEACH BLVD",
            "address_2": "STE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162705",
            "telephone_number": "904-727-7955",
            "fax_number": "904-727-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6269 BEACH BLVD",
            "address_2": "STE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162705",
            "telephone_number": "904-727-7955",
            "fax_number": "904-727-7976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASRAEIAN",
        "first_name": "AHMAD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2012-08-02",
        "deactivation_date": "2006-03-23",
        "reactivation_date": "2006-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "FL",
            "license": "FLME 0029693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043722100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.