Individual provider Active NPI

Sukeshi K Patel, M.D.

  • Pediatrics Physician
  • Jacksonville, FL
National Provider Identifier
1679980122
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME142746 Issued in FL
Practice address
4972 Town Center Pkwy Unit 301
Jacksonville, FL 32246-8596
Phone
(904) 642-6100
Fax
(904) 642-5154
NPI assigned
Jul 16, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME142746 FL Primary

Addresses

Primary practice location

4972 Town Center Pkwy Unit 301
Jacksonville, FL 32246-8596

Mailing address

900 S Pine Island Rd Ste 800
Plantation, FL 33324-3923
Phone (904) 642-6100

Other identifiers 1

IdentifierTypeStateIssuer
105456700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240312002007 FL Practitioner - Pediatric Medicine 4587974415 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME142746FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Ambulatory Care Inc CurrentSince Apr 15, 2024 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Apr 15, 2024 Accepting new patients

Locations

2853 Henley Rd
Ste 104
Green Cove Springs, FL 32043
Phone (904) 602-4330

Interoperability endpoints

  • Direct secure messaging: sukeshi.patel.1@8967.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581465600000",
    "number": "1679980122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S PINE ISLAND RD STE 800",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333243923",
            "telephone_number": "904-642-6100",
            "fax_number": "904-642-5154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4972 TOWN CENTER PKWY UNIT 301",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322468596",
            "telephone_number": "904-642-6100",
            "fax_number": "904-642-5154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "SUKESHI",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-16",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME142746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105456700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.