Physician Associates of Jacksonville, PA

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

ME741014 Issued in FL

Legal business name

PHYSICIAN ASSOCIATES OF JACKSONVILLE, PA

Practice address

2700 Riverside Avenue
Suite#14
Jacksonville, FL 32205

Phone

(904) 389-3770

Fax

(904) 389-3703

NPI assigned

Jan 3, 2007

Last updated

Feb 6, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nag Ravichandran, M.D.

Title

Administrator

Phone

(904) 389-3770

Specialties & licenses 1

Addresses

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/sJsiTAK78Ymqden_ZevYBEoppqMpQx2F/

Practitioners 1

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.

• Kimberly Bravo, ARNP

  • Family Nurse Practitioner
  • Hilliard, FL
  • NPI 1447270400
  NPD (past)

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328486400000",
    "number": "1750448163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 54246",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32245",
            "telephone_number": "904-389-3770",
            "fax_number": "904-389-3703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 RIVERSIDE AVENUE",
            "address_2": "SUITE#14",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32205",
            "telephone_number": "904-389-3770",
            "fax_number": "904-389-3703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN ASSOCIATES OF JACKSONVILLE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2012-02-06",
        "status": "A",
        "authorized_official_last_name": "RAVICHANDRAN",
        "authorized_official_first_name": "NAG",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-389-3770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME741014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Geriatric Medicine (Internal Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.