Active NPI
Integrated Community Oncology Network LLC
- Radiation Oncology Physician
- Jacksonville Beach, FL
National Provider Identifier
1760417042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- Legal business name
- INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC
- Practice address
- 1375 Roberts Dr
Suite 100
Jacksonville Beach, FL 32250-3210 - Phone
- (904) 242-0166
- Fax
- (904) 242-0167
- NPI assigned
- Jul 12, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Shyam B Paryani, MD
- Title
- Director
- Phone
- (904) 309-8680
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | Primary |
Addresses
Primary practice location
1375 Roberts Dr
Suite 100
Jacksonville Beach, FL 32250-3210
Mailing address
PO Box 19675
Jacksonville, FL 32245-9675
Phone (904) 309-8680
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DC6938 | Other | FL | MEDICARE RAILROAD |
| 273427305 | Medicaid | FL | |
| 94890 | Other | FL | BLUE CROSS BLUE SHIELD |
Other names 1
- Florida Radiation Oncology Group
National Provider Directory
National Provider DirectoryLocations
1375 Roberts Dr
Ste 100
Jax Bch, FL 32250
Phone (904) 242-0166
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1421798400000",
"number": "1760417042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19675",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322459675",
"telephone_number": "904-309-8680",
"fax_number": "904-345-5847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1375 ROBERTS DR",
"address_2": "SUITE 100",
"city": "JACKSONVILLE BEACH",
"state": "FL",
"postal_code": "322503210",
"telephone_number": "904-242-0166",
"fax_number": "904-242-0167"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-12",
"last_updated": "2015-01-21",
"status": "A",
"authorized_official_last_name": "PARYANI",
"authorized_official_first_name": "SHYAM",
"authorized_official_middle_name": "B",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "904-309-8680",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Radiation Oncology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "DC6938",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "273427305",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "94890",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Florida Radiation Oncology Group",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Jacksonville Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.