NPIMap

Organization Active NPI

Ackerman Cancer Center, PA

  • Radiation Oncology Physician
  • St Augustine, FL
National Provider Identifier
1750175501
Registry record updated Apr 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
ACKERMAN CANCER CENTER, PA
Practice address
520 W Twincourt TRL Ste 4-5
St Augustine, FL 32095-8987
Phone
(904) 880-5522
NPI assigned
Apr 7, 2025
Last updated
Apr 7, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ACKERMAN CANCER CENTER, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 7, 2025

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

Authorized official

Name
Scot Ackerman, MDNPI 1942205364
Title
Authorized Official
Phone
(904) 880-5522

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X Primary
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X

Addresses

Primary practice location

520 W Twincourt TRL Ste 4-5
St Augustine, FL 32095-8987

Mailing address

PO Box 37016
Tampa, FL 33631-9016
Phone (904) 880-5522

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041229000504 FL Part B Supplier - Clinic/Group Practice 3779541362 Receives reassigned benefits from 19 practitioners
7 other NPIs on this enrollment
Practice locations: Fernandina Beach, FL; St Augustine, FL; Middleburg, FL; Jacksonville, FL

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Ackerman Cancer Center PA10 organizations share this tax ID, including this one
Part of
Ackerman Cancer Center PA

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1340 S 18th St
Ste 103
Fernandina Beach, FL 32034
Phone (904) 277-2700

3839 County Road 218
Middleburg, FL 32068
Phone (904) 282-5474

520 W Twincourt Trl
Ste 45
Saint Augustine, FL 32095
Phone (904) 880-5522

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1743984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743984000000",
    "number": "1750175501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37016",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336319016",
            "telephone_number": "904-880-5522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 W TWINCOURT TRL STE 4-5",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320958987",
            "telephone_number": "904-880-5522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACKERMAN CANCER CENTER, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ACKERMAN CANCER CENTER, PA",
        "enumeration_date": "2025-04-07",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A",
        "authorized_official_last_name": "ACKERMAN",
        "authorized_official_first_name": "SCOT",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "904-880-5522",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; 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.

Verify at the official NPI Registry.