NPIMap

Organization Active NPI

Flagler Family Nursing Home Care LLC

  • Family Medicine Physician
  • St Augustine, FL
National Provider Identifier
1679172779
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FLAGLER FAMILY NURSING HOME CARE LLC
Practice address
130 Healthpark Blvd
St Augustine, FL 32086-5776
Phone
(904) 826-3469
Fax
(904) 679-3169
NPI assigned
Oct 20, 2020
Last updated
Oct 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Authorized official

Name
Christopher Zub, DONPI 1972560506
Title
Authorized Official/Partner
Phone
(904) 826-3469

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

130 Healthpark Blvd
St Augustine, FL 32086-5776

Mailing address

130 Healthpark Blvd
St Augustine, FL 32086-5776
Phone (904) 826-3469

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210510000145 FL Part B Supplier - Clinic/Group Practice 4486063120 Receives reassigned benefits from 17 practitioners
Practice locations: St Augustine, FL

National Provider Directory

National Provider Directory

Member of 1

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

Locations

130 Health Park Blvd
St Augustine, FL 32086
Phone (904) 826-3469

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1679172779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 HEALTHPARK BLVD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865776",
            "telephone_number": "904-826-3469",
            "fax_number": "904-679-3169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 HEALTHPARK BLVD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865776",
            "telephone_number": "904-826-3469",
            "fax_number": "904-679-3169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLAGLER FAMILY NURSING HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-20",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "ZUB",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL/PARTNER",
        "authorized_official_telephone_number": "904-826-3469",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.