NPIMap

Organization Active NPI

Northeast Florida Endocrine and Diabetes Associates PA

  • Specialist
  • Jacksonville, FL
National Provider Identifier
1750582565
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
NORTHEAST FLORIDA ENDOCRINE AND DIABETES ASSOCIATES PA
Practice address
1375 Roberts Dr Ste 206
Jacksonville, FL 32250-3209
Phone
(904) 384-2240
Fax
(904) 384-6055
NPI assigned
May 30, 2007
Last updated
Jun 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Authorized official

Name
Mrs. Elena F Oravetz
Title
Credentialing
Phone
(904) 384-2240

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary
General Practice Physician 208D00000X NU

Addresses

Primary practice location

1375 Roberts Dr Ste 206
Jacksonville, FL 32250-3209

Mailing address

1375 Roberts Dr
Suite 202
Jacksonville, FL 32250-3210
Phone (904) 384-2240

Other identifiers 1

IdentifierTypeStateIssuer
374606200MedicaidFL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2131148Northeast Florida Endocrine1375 Roberts Drive Ste 202, Jacksonville Beach, FL 32250Certificate of waiverMay 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
NE Fla Endocrine Diab14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

1375 Roberts Dr
Ste 202
Jacksonville Beach, FL 32250

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1750582565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1375 ROBERTS DR",
            "address_2": "SUITE 202",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322503210",
            "telephone_number": "904-384-2240",
            "fax_number": "904-384-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 ROBERTS DR STE 206",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322503209",
            "telephone_number": "904-384-2240",
            "fax_number": "904-384-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST FLORIDA ENDOCRINE AND DIABETES ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A",
        "authorized_official_last_name": "ORAVETZ",
        "authorized_official_first_name": "ELENA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "904-384-2240",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "374606200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.

Verify at the official NPI Registry.