Active NPI
Thomas Mark Lundy, PA
- Physician Assistant
- Jacksonville, FL
National Provider Identifier
1720113533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA2439
- Practice address
- 9090 Regency Square Blvd
Credentialing Department
Jacksonville, FL 32211-8119 - Phone
- (904) 724-5576
- Fax
- (904) 724-0721
- NPI assigned
- Feb 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA2439 | FL | Primary |
Addresses
Primary practice location
9090 Regency Square Blvd
Credentialing Department
Jacksonville, FL 32211-8119
Mailing address
PO Box 40767
Credentialing Department
Jacksonville, FL 32203-0767
Phone (904) 376-3707
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2439 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422835200000",
"number": "1720113533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 40767",
"address_2": "CREDENTIALING DEPARTMENT",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322030767",
"telephone_number": "904-376-3707",
"fax_number": "904-391-5807"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9090 REGENCY SQUARE BLVD",
"address_2": "CREDENTIALING DEPARTMENT",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322118119",
"telephone_number": "904-724-5576",
"fax_number": "904-724-0721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNDY",
"first_name": "THOMAS",
"middle_name": "MARK",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-22",
"last_updated": "2015-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA2439",
"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 Feb 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.