NPIMap

Organization Active NPI

Pacifica Care PLLC

  • Adult Mental Health Clinic/Center
  • Jacksonville, FL
National Provider Identifier
1669775037
Registry record updated Jan 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
HCC8789 Issued in FL
Legal business name
PACIFICA CARE PLLC
Practice address
13121 Atlantic Blvd
Suite 100
Jacksonville, FL 32225
Phone
(904) 221-2232
Fax
(904) 221-2205
NPI assigned
Dec 7, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2012

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

Authorized official

Name
Peggy A Arcanz
Title
Administrator
Phone
(904) 221-2232

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 9102783 FL
Adult Mental Health Clinic/Center 261QM0850X HCC8789 FL Primary

Addresses

Primary practice location

13121 Atlantic Blvd
Suite 100
Jacksonville, FL 32225

Mailing address

13121 Atlantic Blvd
Suite 100
Jacksonville, FL 32225
Phone (904) 221-2232

Other identifiers 1

IdentifierTypeStateIssuer
292650400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110606000563 FL Part B Supplier - Clinic/Group Practice 7911184692 Receives reassigned benefits from 8 practitioners
Practice locations: Jacksonville, FL; Punta Gorda, FL

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
10D2017795Pacifica Care PLLC13121 Atlantic Blvd Ste 100, Jacksonville, FL 32225Certificate of waiverDec 16, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1291680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326153600000",
    "number": "1669775037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13121 ATLANTIC BLVD",
            "address_2": "SUITE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32225",
            "telephone_number": "904-221-2232",
            "fax_number": "904-221-2205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13121 ATLANTIC BLVD",
            "address_2": "SUITE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32225",
            "telephone_number": "904-221-2232",
            "fax_number": "904-221-2205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFICA CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-07",
        "last_updated": "2012-01-10",
        "status": "A",
        "authorized_official_last_name": "ARCANZ",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-221-2232"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "FL",
            "license": "9102783",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "FL",
            "license": "HCC8789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292650400",
            "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 Jan 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.