Active NPI
J Edward Hartley, DC
- Neurology Chiropractor
- Saint Augustine, FL
National Provider Identifier
1750458378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Chiropractor
- License
- 6696
- Practice address
- 1740 Tree Blvd
Ste 115
Saint Augustine, FL 32084-5720 - Phone
- (904) 679-3233
- Fax
- (904) 679-3599
- NPI assigned
- Nov 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Neurology Chiropractor | 111NN0400X | 6696 | FL | Primary |
Addresses
Primary practice location
1740 Tree Blvd
Ste 115
Saint Augustine, FL 32084-5720
Mailing address
1740 Tree Blvd
Ste 115
Saint Augustine, FL 32084-5720
Phone (904) 679-3233
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 380921800 | Medicaid | FL | |
| 593375448 | Other | FL | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1992
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1740 Tree Blvd
Suite 115
St Augustine, FL 32084-5720
Phone (904) 679-3233
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6696 | FL | MD | Dermatology Physician |
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 and National Provider Directory roles.
-
- Chiropractor
- Saint Augustine, FL
- NPI 1962952101
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488240000000",
"number": "1750458378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1740 TREE BLVD",
"address_2": "STE 115",
"city": "SAINT AUGUSTINE",
"state": "FL",
"postal_code": "320845720",
"telephone_number": "904-679-3233",
"fax_number": "904-679-3599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1740 TREE BLVD",
"address_2": "STE 115",
"city": "SAINT AUGUSTINE",
"state": "FL",
"postal_code": "320845720",
"telephone_number": "904-679-3233",
"fax_number": "904-679-3599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARTLEY",
"first_name": "J",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-29",
"last_updated": "2017-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "111NN0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Neurology",
"state": "FL",
"license": "6696",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "380921800",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "593375448",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.