NPIMap

Organization Active NPI

St. Vincent's Medical Center, Inc.

Doing business as Ascension St Vincent's Riverside

  • Clinical Medical Laboratory
  • Jacksonville, FL
National Provider Identifier
1669556072
Registry record updated Mar 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
10D0645096 Issued in FL
Legal business name
ST. VINCENT'S MEDICAL CENTER, INC.
Doing business as
Ascension St Vincent's Riverside
Consolidated Laboratory Services
Practice address
4203 Belfort Rd
Suite 106
Jacksonville, FL 32216-1409
Phone
(904) 308-5600
Fax
(904) 296-1589
NPI assigned
Oct 24, 2006
Last updated
Mar 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. VINCENT'S MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 21, 2022

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

Authorized official

Name
Jon Cooper
Title
President
Phone
(904) 308-8194

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 10D0645096 FL Primary

Addresses

Primary practice location

4203 Belfort Rd
Suite 106
Jacksonville, FL 32216-1409

Mailing address

1 Shircliff Way
Jacksonville, FL 32204-4748
Phone (904) 308-7300

Other identifiers 2

IdentifierTypeStateIssuer
010073102MedicaidFL
L8520OtherFLBCBS FACILITY

Other names 2

  • ASCENSION ST VINCENT'S RIVERSIDE Doing business as
  • Consolidated Laboratory Services Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101011000685 FL Part A Provider - Hospital 0244144558 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Orange Park, FL; Jacksonville, FL
O20160922002879 FL Part B Supplier - Hospital Department(S) 0244144558 Practice locations: Jacksonville, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669556072. Details of each certification follow.

Hospital certification: CCN 100040

Legal name
ST VINCENTS MEDICAL CENTER INC
Doing business as
ASCENSION ST. VINCENT'S RIVERSIDE
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 16, 2023
Beds
584
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Nov 10, 1969 in FL
Enrollment address
1 Shircliff Way
Jacksonville, FL 32204-4748
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Ascension St Vincent's RiversideCCN 100040 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2080894St Luke's-St Vincent's Healthcare, Inc4203 Belfort Rd, Suite 103, Jacksonville, FL 32216Certificate of waiverJul 15, 2028

National Provider Directory

National Provider Directory
Tax ID family
Margaret H Duffy MD3 organizations share this tax ID, including this one
Part of
Margaret H Duffy MD

Other organizations with this tax ID 2

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2585 Oak St
Jacksonville, FL 32204
Phone (904) 308-5600

4203 Belfort Rd
Ste 106
Jacksonville, FL 32216
Phone (904) 308-5600

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/A8JBVvRX_lChZDLoNxFeQ8N_64m_7so-/

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jeremy Kraft Individual Corporate DirectorDirector - Net Revenue Aug 10, 2016
W-2 Managing EmployeeDirector- Net Revenue Aug 10, 2016
Helen Rowan Individual Corporate DirectorBoard Member Jul 1, 2015
Coba Cornejo Individual Corporate OfficerChief Operating Officer Jun 1, 2018
W-2 Managing Employee Jun 1, 2018
Don King Individual Corporate OfficerSenior Vice President May 1, 2023
W-2 Managing EmployeeSenior Vice President May 1, 2023
Operational/Managerial ControlSenior Vice President May 1, 2023
Scott Kashman Individual Corporate OfficerPresident Jul 1, 2024
W-2 Managing EmployeePresident Jul 1, 2024
Operational/Managerial ControlPresident Jul 1, 2024
Patrick George Individual Corporate OfficerChief Financial Officer Jun 1, 2026
W-2 Managing EmployeeChief Financial Officer Jun 1, 2026
Operational/Managerial ControlChief Financial Officer Jun 1, 2026
St. Vincent's Health System, Inc. Organization, Jacksonville, FL Corporation 5% Or Greater Direct Ownership Interest Jul 1, 1966
Operational/Managerial Control Jul 1, 1966

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • St Vincents Health System Inc

    dba Ascension St Vincent's St. Johns County

    • General Acute Care Hospital
    • Saint Johns, FL
    • NPI 1861078651

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Affiliated clinicians 850

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 850

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647820800000",
    "number": "1669556072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SHIRCLIFF WAY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044748",
            "telephone_number": "904-308-7300",
            "fax_number": "904-308-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4203 BELFORT RD",
            "address_2": "SUITE 106",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161409",
            "telephone_number": "904-308-5600",
            "fax_number": "904-296-1589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. VINCENT'S MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. VINCENT'S MEDICAL CENTER, INC.",
        "enumeration_date": "2006-10-24",
        "last_updated": "2022-03-21",
        "certification_date": "2022-02-23",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-308-8194"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "10D0645096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010073102",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FACILITY",
            "identifier": "L8520",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ASCENSION ST VINCENT'S RIVERSIDE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Consolidated Laboratory Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Consolidated Laboratory Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.