NPIMap

Organization Active NPI

Physical Healthcare of Jacksonville Inc

  • Internal Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1760722011
Registry record updated Apr 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME55161 Issued in FL
Legal business name
PHYSICAL HEALTHCARE OF JACKSONVILLE INC
Practice address
12620 Beach Blvd
Suite 6
Jacksonville, FL 32246-7131
Phone
(904) 645-0777
Fax
(904) 645-3483
NPI assigned
Feb 25, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2017

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

Authorized official

Name
Mark A Pierce, DCNPI 1962448209
Title
Clinic Director
Phone
(904) 645-0777

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 10

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH6451 FL
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH6588 FL
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH4435 FL
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X ME55161 FL Primary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X ME0060908 FL
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT30658 FL
Durable Medical Equipment & Medical Supplies 332B00000X ME0060908 FL
Durable Medical Equipment & Medical Supplies 332B00000X ME55161 FL
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X PA9106788 FL
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X ARNP 770742 FL

Addresses

Primary practice location

12620 Beach Blvd
Suite 6
Jacksonville, FL 32246-7131

Mailing address

12620 Beach Blvd
Suite 6
Jacksonville, FL 32246-7131
Phone (904) 645-0777

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130604000286 FL Part B Supplier - Clinic/Group Practice 9234376690 Receives reassigned benefits from 14 practitioners
Practice locations: Jacksonville, FL

National Provider Directory

National Provider Directory

Locations

12620 Beach Blvd
Jacksonville, FL 32246
Phone (904) 564-3586

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1361750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492473600000",
    "number": "1760722011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12620 BEACH BLVD",
            "address_2": "SUITE 6",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322467131",
            "telephone_number": "904-645-0777",
            "fax_number": "904-645-3483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12620 BEACH BLVD",
            "address_2": "SUITE 6",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322467131",
            "telephone_number": "904-645-0777",
            "fax_number": "904-645-3483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL HEALTHCARE OF JACKSONVILLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-25",
        "last_updated": "2017-04-18",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "904-645-0777",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH6451",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH6588",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH4435",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME55161",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "FL",
            "license": "ME0060908",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT30658",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "ME0060908",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "ME55161",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9106788",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP 770742",
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Apr 18, 2017; 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.