Active NPI
Podiatry Associates of Florida Inc
- Podiatrist
- Orange Park, FL
National Provider Identifier
1730280249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- Legal business name
- PODIATRY ASSOCIATES OF FLORIDA INC
- Practice address
- 2140 Kingsley Ave Ste 12
Orange Park, FL 32073 - Phone
- (904) 224-2000
- Fax
- (904) 224-2002
- NPI assigned
- Sep 26, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jeannie M Baskin
- Title
- Corporate Administrator
- Phone
- (904) 224-2001
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | Primary |
Addresses
Primary practice location
2140 Kingsley Ave Ste 12
Orange Park, FL 32073
Mailing address
2140 Kingsley Ave Ste 12
Orange Park, FL 32073-5129
Phone (904) 224-2001
Other practice location 1
3117 Spring Glen Rd
Ste 402
Jacksonville, FL 32207-5906
Phone (904) 224-2001
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65484 | Other | BLUE CROSS BLUE SHIELD | |
| 65238 | Other | BLUE CROSS BLUE SHIELD | |
| 87303 | Other | BLUE CROSS BLUE SHIELD | |
| CN7223 | Other | RAILROAD MEDICARE | |
| 480025512 | Other | RAILROAD MEDICARE | |
| P00603525 | Other | RAILROAD MEDICARE | |
| 480025511 | Other | RAILROAD MEDICARE | |
| 480025510 | Other | RAILROAD MEDICARE |
Other names 1
- Podiatry Associates of Northeast Florida Inc
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050324000347 | FL | Part B Supplier - Clinic/Group Practice | 8820044688 |
Receives reassigned benefits from 16 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jacksonville, FL; Orange Park, FL; Jacksonville Beach, FL; Clearwater, FL |
Other NPIs on the same Medicare enrollment 13
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Foot & Ankle Surgery Podiatrist
- Orange Park, FL
- NPI 1083715502
O20050324000347
-
- Foot & Ankle Surgery Podiatrist
- Jacksonville, FL
- NPI 1588765036
O20050324000347
National Provider Directory
National Provider DirectoryLocations
5911 Timuquana Rd
Unit 300
Jacksonville, FL 32210
Phone (904) 778-3000
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1552608000000",
"number": "1730280249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2140 KINGSLEY AVE STE 12",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320735129",
"telephone_number": "904-224-2001",
"fax_number": "904-224-2002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2140 KINGSLEY AVE STE 12",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "32073",
"telephone_number": "904-224-2000",
"fax_number": "904-224-2002"
}
],
"practiceLocations": [
{
"address_1": "3117 Spring Glen Rd",
"address_2": "Ste 402",
"address_purpose": "LOCATION",
"city": "Jacksonville",
"state": "FL",
"postal_code": "322075906",
"country_code": "US",
"telephone_number": "904-224-2001",
"fax_number": "904-224-2002",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "PODIATRY ASSOCIATES OF FLORIDA INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-26",
"last_updated": "2019-03-15",
"status": "A",
"authorized_official_last_name": "BASKIN",
"authorized_official_first_name": "JEANNIE",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "CORPORATE ADMINISTRATOR",
"authorized_official_telephone_number": "904-224-2001"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Podiatrist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "65484",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "65238",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "87303",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "CN7223",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "480025512",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00603525",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "480025511",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "480025510",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Podiatry Associates of Northeast Florida Inc",
"code": "4",
"type": "Former Legal Business Name"
},
{
"organization_name": "Podiatry Associates of Northeast Florida Inc",
"code": "4",
"type": "Former Legal Business Name"
}
]
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.