NPIMap

Individual provider Active NPI

Harry Madhanagopal, D.O.

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1740568278
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02004163A Issued in IN
Practice address
9130 RG Skinner
Jacksonville, FL 32256
Phone
(049) 538-0950
Fax
(904) 538-0952
NPI assigned
Aug 2, 2011
Last updated
Jan 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02004163A IN Primary

Addresses

Primary practice location

9130 RG Skinner
Jacksonville, FL 32256

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623
Phone (904) 296-5691

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
I20181019002151 FL Practitioner - Family Practice 5890928899 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
First Coast Family Medicine PAGroup PAC ID 4880791375, 5 clinicians

Practice addresses (Care Compare)

9130 RG Skinner Pkwy
Jacksonville, FL 32256-9661
Phone (904) 538-0950

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02004163AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
First Coast Family Medicine PA Family Medicine CurrentSince Feb 6, 2024 Accepting new patients
St Vincent's Full Service Urgent Care, LLC CurrentSince Sep 1, 2018 Accepting new patients

Locations

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

6699 Gate Pkwy
Ste A
Jacksonville, FL 32256
Phone (904) 296-5688

7963 Normandy Blvd
Jacksonville, FL 32221
Phone (904) 379-1203

858 Monument Rd
Ste A
Jacksonville, FL 32225
Phone (904) 450-6600

9130 R G Skinner Pkwy
Jacksonville, FL 32256
Phone (904) 538-0950

Interoperability endpoints

  • Direct secure messaging: harry.madhanagopal.1@16062.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.

Hospital & facility affiliations 6

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": "1312243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1740568278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623",
            "telephone_number": "904-296-5691",
            "fax_number": "904-450-6401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9130 RG SKINNER",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "049-538-0950",
            "fax_number": "904-538-0952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADHANAGOPAL",
        "first_name": "HARRY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-02",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02004163A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.