Anastasia Medical Group, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

ANASTASIA MEDICAL GROUP, LLC

Practice address

1301 Plantation Island Drive
Suite 203a
St Augustine, FL 32080

Phone

(904) 461-0821

Fax

(904) 461-0823

NPI assigned

Apr 11, 2006

Last updated

Jan 15, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Suhas P Neerukonda, MDNPI 1538145602

Title

Managing Partner

Phone

(904) 461-0343

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Suhas P Neerukonda, MD

  • Internal Medicine Physician
  • St Augustine, FL
  • NPI 1538145602
  Medicare reassignment Care Compare group NPD Authorized official
• Cindy O Chaconas, DPT, ATC

  • Physical Therapist
  • St Augustine, FL
  • NPI 1518339761
  Medicare reassignment Care Compare group NPD
• Ryan J Pereira, DPM

  • Foot & Ankle Surgery Podiatrist
  • St Augustine, FL
  • NPI 1033195979
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705276800000",
    "number": "1710940648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DRIVE",
            "address_2": "SUITE 203A",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "32080",
            "telephone_number": "904-461-0821",
            "fax_number": "904-461-0823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DRIVE",
            "address_2": "SUITE 203A",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "32080",
            "telephone_number": "904-461-0821",
            "fax_number": "904-461-0823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANASTASIA MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2024-01-15",
        "certification_date": "2024-01-15",
        "status": "A",
        "authorized_official_last_name": "NEERUKONDA",
        "authorized_official_first_name": "SUHAS",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "904-461-0343",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "99767",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "277020200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amir a Malik MD PA
• Amnath Kirdnual, M.D., P.a.
• Jacques Howard Amole, DNP, APRN
• Anastasia Dental Associates PLLC
• Anastasia Family and Urgent Care
• Anastasia Pediatrics
• Ancient City Acupuncture and Herbal Medicine
• Ancient City Children's Therapy, LLC
• Ancient City Diagnostics, LLC
• Ancient City Midwives Inc

• Internal Medicine Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2024; 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.