NPIMap

Individual provider Active NPI

Michael Beirns Brumback, M.D.

  • Nephrology Physician
  • Jacksonville, FL
National Provider Identifier
1740235787
Registry record updated Dec 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME 84983 Issued in FL
Practice address
2 Shircliff Way
Suite 700 Depaul BLDG.
Jacksonville, FL 32204-4763
Phone
(904) 389-5333
Fax
(904) 389-5332
NPI assigned
May 24, 2006
Last updated
Dec 29, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X ME 84983 FL Primary

Addresses

Primary practice location

2 Shircliff Way
Suite 700 Depaul BLDG.
Jacksonville, FL 32204-4763

Mailing address

2 Shircliff Way
Suite 700 Depaul BLDG.
Jacksonville, FL 32204-4763
Phone (904) 389-5333

Other identifiers 1

IdentifierTypeStateIssuer
269052700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110330000836 FL Practitioner - Nephrology 4385662725 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Emory University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
James D Baker III MD PAGroup PAC ID 9032011663, 19 clinicians

Practice addresses (Care Compare)

2 Shircliff Way 700 Depaul BLDG
Nephrology Associates of Northeast
Jacksonville, FL 32204-4759
Phone (904) 389-5333

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 84983FLMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
James D. Baker III, M.D., PA Nephrology CurrentSince Sep 3, 2002 Accepting new patients

Locations

1760 Edgewood Ave W
Jacksonville, FL 32208
Phone (904) 253-1030

2 Shircliff Way
Ste 415
Jacksonville, FL 32204
Phone (904) 389-5333

2 Shircliff Way
Ste 700
Jacksonville, FL 32204
Phone (904) 387-3001

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 1

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.

Hospital & facility affiliations 7

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": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482969600000",
    "number": "1740235787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 SHIRCLIFF WAY",
            "address_2": "SUITE 700 DEPAUL BLDG.",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044763",
            "telephone_number": "904-389-5333",
            "fax_number": "904-389-5332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SHIRCLIFF WAY",
            "address_2": "SUITE 700 DEPAUL BLDG.",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044763",
            "telephone_number": "904-389-5333",
            "fax_number": "904-389-5332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUMBACK",
        "first_name": "MICHAEL",
        "middle_name": "BEIRNS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2016-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME 84983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269052700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.