Individual provider Active NPI

Aisha Amin, MD

  • Internal Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1689957482
Registry record updated Feb 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME116728 Issued in FL
Practice address
800 Prudential Dr
Jacksonville, FL 32207-8202
Phone
(904) 202-2000
Fax
(904) 281-9806
NPI assigned
Sep 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125056653 IL
Internal Medicine Physician 207R00000X ME116728 FL Primary

Addresses

Primary practice location

800 Prudential Dr
Jacksonville, FL 32207-8202

Mailing address

4466 Swilcan Bridge LN N
Jacksonville, FL 32224-5617
Phone (904) 281-0944

Other identifiers 2

IdentifierTypeStateIssuer
14SU9OtherFLBCBS
009362500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20170612002062 TX Practitioner - Internal MedicinePractitioner - Nephrology 8022261668 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Other, 2001
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4003 Woodlawn Ave
Pasadena, TX 77504-1910
Phone (713) 941-0088

Hospital & facility affiliations

  • HCA Houston Healthcare Clear Lake Hospital, Webster, TX, CCN 450617
  • HCA Houston Healthcare Southeast Hospital, Pasadena, TX, CCN 450097

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125056653ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
PCP Associates of Pasadena PA CurrentSince Jan 22, 2018 Accepting new patients
Aa Kidney Care PLLC CurrentSince Feb 1, 2021 Accepting new patients
Lung Center Associates CurrentSince Nov 1, 2017 Accepting new patients

Locations

5030 Crenshaw Rd
Ste 120
Pasadena, TX 77505
Phone (713) 943-8229

4003 Woodlawn Ave
Pasadena, TX 77504
Phone (713) 941-0088

500 W Medical Center Blvd
Webster, TX 77598
Phone (713) 447-4650

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/5911/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1317168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391385600000",
    "number": "1689957482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4466 SWILCAN BRIDGE LN N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322245617",
            "telephone_number": "904-281-0944",
            "fax_number": "904-281-9806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 PRUDENTIAL DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078202",
            "telephone_number": "904-202-2000",
            "fax_number": "904-281-9806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMIN",
        "first_name": "AISHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-28",
        "last_updated": "2014-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125056653",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME116728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "14SU9",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009362500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.