Individual provider Active NPI

Yazan Radaideh

  • Neurology Physician
  • Jacksonville, FL
National Provider Identifier
1720460132
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
165048 Issued in FL
Practice address
580 W 8TH St FL Toweri9
Jacksonville, FL 32209-6533
Phone
(904) 244-9092
NPI assigned
Jun 22, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 165048 FL Primary

Addresses

Primary practice location

580 W 8TH St FL Toweri9
Jacksonville, FL 32209-6533

Mailing address

580 W 8TH St FL Tower19
Jacksonville, FL 32209-6533
Phone (904) 244-9092

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
I20230512002563 FL Practitioner - Neurology 0749527828 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1 Shircliff Way
Jacksonville, FL 32204-4748
Phone (904) 308-7300

15255 Max Leggett Pkwy
Jacksonville, FL 32218-7213
Phone (904) 383-1000

580 W 8TH St
Jacksonville, FL 32209-6533
Phone (904) 244-9800

653 W 8TH St
Jacksonville, FL 32209-6511
Phone (904) 244-1680

655 W 8TH St
Jacksonville, FL 32209-6511
Phone (940) 244-4218

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
59.59 of 100Reported as apm
Quality
59.93
Promoting interoperability
0
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
165048FLMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians, Inc. Neurology Current Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince May 1, 2023 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince May 1, 2023 Accepting new patients

Locations

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

580 W 8th St
#19
Jacksonville, FL 32209

580 W 8th St
#9
Jacksonville, FL 32209
Phone (904) 244-9092

580 W 8th St
Fl 9
Jacksonville, FL 32209
Phone (904) 244-9092

1 Shircliff Way
Jacksonville, FL 32204
Phone (904) 332-0414

Interoperability endpoints

  • Direct secure messaging: yradaideh631871@direct.shands.ufl.edu

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": "1434931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1720460132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 W 8TH ST FL TOWER19",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096533",
            "telephone_number": "904-244-9092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 W 8TH ST FL TOWERI9",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096533",
            "telephone_number": "904-244-9092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADAIDEH",
        "first_name": "YAZAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-22",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "165048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.