Active NPI
Michelle Renae Mendez, D.O.
- Family Medicine Physician
- Jacksonville Beach, FL
National Provider Identifier
1740202456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS7488
- Practice address
- 1909 Beach Blvd
Suite 102
Jacksonville Beach, FL 32250-8608 - Phone
- (904) 246-2752
- Fax
- (904) 246-2758
- NPI assigned
- Jul 24, 2006
- Last updated
- Jun 9, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS7488 | FL | Primary |
Addresses
Primary practice location
1909 Beach Blvd
Suite 102
Jacksonville Beach, FL 32250-8608
Mailing address
PO Box 440055
Jacksonville, FL 32222-0001
Phone (904) 282-6331
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 268106400 | Medicaid | FL | |
| P00369612 | Other | FL | MEDICARE RAILROAD |
Other names 1
- Michelle Renae Edsrom
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Nova Southeastern College of Osteo Medicine, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1909 Beach Blvd
Suite 102
Jacksonville Beach, FL 32250-2643
Phone (904) 246-2752
Hospital & facility affiliations
- Baptist Home Health Care by Bayada
- Baptist Medical Center Beaches
- Baptist Health Medical Center - Jacksonville
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 22 |
| Removal of nail tissue | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS7488 | FL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mendez Family Care PA | Family Medicine | Current | Accepting new patients |
| Physicians Group Services PA | Family Medicine | Past | Accepting new patients |
Locations
1909 Beach Blvd
Ste 102
Jax Bch, FL 32250
Phone (904) 246-2752
Interoperability endpoints
- michelle.mendez.1@29137.direct.athenahealth.com
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Jacksonville Beach, FL
- NPI 1205854171
-
dba Coastal Health
- Family Medicine Physician
- Orange Park, FL
- NPI 1861440810
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Jacksonville Beach, FL
- NPI 1821155912
-
dba Baptist Home Health Care by BAYADA
- Home Health Agency
- Jacksonville, FL
- NPI 1023612884
-
dba Baptist Medical Center
- General Acute Care Hospital
- Jacksonville, FL
- NPI 1578620449
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686268800000",
"number": "1740202456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 440055",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322220001",
"telephone_number": "904-282-6331",
"fax_number": "904-282-1550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1909 BEACH BLVD",
"address_2": "SUITE 102",
"city": "JACKSONVILLE BEACH",
"state": "FL",
"postal_code": "322508608",
"telephone_number": "904-246-2752",
"fax_number": "904-246-2758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDEZ",
"first_name": "MICHELLE",
"middle_name": "RENAE",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-24",
"last_updated": "2023-06-09",
"certification_date": "2023-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "OS7488",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "268106400",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00369612",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MICHELLE",
"last_name": "EDSROM",
"middle_name": "RENAE",
"credential": "D.O.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Jacksonville Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.