Abdallah Mohamed Jeroudi, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME130764 Issued in FL

Practice address

2639 Oak St
Jacksonville, FL 32204-4505

Phone

(904) 387-5600

Fax

(904) 388-0114

NPI assigned

Apr 12, 2011

Last updated

Apr 20, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA, FL2 enrollments

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 2

Specialty

Ophthalmology

Education

Baylor College of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Retina Vitreous ConsultantsGroup PAC ID 4082610019, 43 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St Vincent's Riverside Hospital, Jacksonville, FL, CCN 100040

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

99

Promoting interoperability

99

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Retina Vitreous Consultants

  dba Retina Group of Florida

  • Ophthalmology Physician
  • Fort Lauderdale, FL
  • NPI 1699773796

  GA

  Medicare reassignment Care Compare group NPD
• The Retina Institute LLC

  dba Barnes Retina Institute

  • Ophthalmology Physician
  • Saint Louis, MO
  • NPI 1407858673
  NPD (past)

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

• St Vincents Medical Center Inc

  dba Ascension St. Vincent's Riverside

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1134117575
  Care Compare affiliation
• St. Vincent's Medical Center, Inc.

  dba Ascension St Vincent's Riverside

  • Clinical Medical Laboratory
  • Jacksonville, FL
  • NPI 1669556072

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1302566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681948800000",
    "number": "1730479650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8786 PERIMETER PARK BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166347",
            "telephone_number": "904-997-9202",
            "fax_number": "904-997-9205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2639 OAK ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044505",
            "telephone_number": "904-387-5600",
            "fax_number": "904-388-0114"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "304 Riverside Dr",
            "address_purpose": "LOCATION",
            "city": "Waycross",
            "state": "GA",
            "postal_code": "315014549",
            "country_code": "US",
            "telephone_number": "912-283-1400",
            "fax_number": "912-283-0019",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 Plantation Island Dr S Ste 130",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320805173",
            "country_code": "US",
            "telephone_number": "904-826-0663",
            "fax_number": "904-826-0664",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8786 Perimeter Park Blvd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322166347",
            "country_code": "US",
            "telephone_number": "904-997-9202",
            "fax_number": "904-997-9205",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "50 Leanni Way Unit E5",
            "address_purpose": "LOCATION",
            "city": "Palm Coast",
            "state": "FL",
            "postal_code": "321374757",
            "country_code": "US",
            "telephone_number": "386-447-1847",
            "fax_number": "386-447-1848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEROUDI",
        "first_name": "ABDALLAH",
        "middle_name": "MOHAMED",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-12",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "GA",
            "license": "77496",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME130764",
            "primary": true
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "GA",
            "license": "77496",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "FL",
            "license": "ME130764",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019742700",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003188625",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ajeroudi@floridaretinainstitute.intellechartdirect.net",
            "affiliation": "N",
            "address_1": "2639 Oak St",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322044505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kelsey Jernigan
• Jerome Weitzen OD PA
• Magdala Jerome-Saintil
• Jazmin L Jerome, MSW, RCSWI
• Tabita Jerome
• Julie Jerue, MSN, RN, LMT, CHT
• Lisa Jessamine, OT
• Jesse P McRae M D P a
• Natalie Jesseman
• Sandra Granger Jessup, CRNA

• Ophthalmology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.