NPIMap

Organization Active NPI

Ideal Image

  • Family Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1679878904
Registry record updated Jan 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
9193543 Issued in FL
Legal business name
IDEAL IMAGE
Practice address
4866 Big Island Dr
Ste #5
Jacksonville, FL 32246-7498
Phone
(904) 652-0652
NPI assigned
Jan 18, 2011
Last updated
Jan 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2011

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

Authorized official

Name
Dr. Richard Dean Glassman
Title
Medical Director
Phone
(904) 652-0652

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 9193543 FL Primary

Addresses

Primary practice location

4866 Big Island Dr
Ste #5
Jacksonville, FL 32246-7498

Mailing address

4866 Big Island Dr
Ste #5
Jacksonville, FL 32246-7498

National Provider Directory

National Provider Directory

Locations

4866 Big Island Dr
Unit 5
Jacksonville, FL 32246
Phone (904) 652-0651

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1295308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295308800000",
    "number": "1679878904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4866 BIG ISLAND DR",
            "address_2": "STE #5",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322467498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4866 BIG ISLAND DR",
            "address_2": "STE #5",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322467498",
            "telephone_number": "904-652-0652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL IMAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-18",
        "last_updated": "2011-01-18",
        "status": "A",
        "authorized_official_last_name": "GLASSMAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "904-652-0652",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9193543",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.