NPIMap

Organization Active NPI

At Home Palliative Care, LLC

Doing business as At Home Primary Care of Georgia, LLC

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Jacksonville, FL
National Provider Identifier
1790406148
Registry record updated May 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X
Legal business name
AT HOME PALLIATIVE CARE, LLC
Doing business as
At Home Primary Care of Georgia, LLC
At Home Palliative Care
Practice address
263 River Hills Dr Ste 3
Jacksonville, FL 32216-8980
Phone
(904) 222-2273
Fax
(904) 902-8227
NPI assigned
Sep 5, 2022
Last updated
May 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2025

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

Authorized official

Name
Crystal Ciszek, FNP-CNPI 1124486089
Title
Ceo
Phone
(478) 290-0677

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X NU Primary

Addresses

Primary practice location

263 River Hills Dr Ste 3
Jacksonville, FL 32216-8980

Mailing address

463688 State Road 200, Ste 1
#364
Yulee, FL 32097
Phone (478) 290-0677

Other practice location 1

10752 Deerwood Park Blvd Ste 100
Jacksonville, FL 32256-4846
Phone (478) 290-0677

Other practice location 2

1601 Hwy 40 E Ste M-151
Kingsland, GA 31548-6500
Phone (904) 222-2273

Other practice location 3

1000 Vintage Brunswick Cir Ste 1
Brunswick, GA 31525-1217
Phone (904) 222-2273

Other names 2

  • AT HOME PRIMARY CARE OF GEORGIA, LLC Doing business as
  • At Home Palliative Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20221101002396 FL Part B Supplier - Clinic/Group Practice 3274900410 Receives reassigned benefits from 7 practitioners
Practice locations: Jacksonville, FL
O20230510000192 GA Part B Supplier - Clinic/Group Practice 3274900410 Receives reassigned benefits from 3 practitioners
Practice locations: Brunswick, GA

National Provider Directory

National Provider Directory

Locations

263 River Hills Dr
Ste 3
Jacksonville, FL 32216
Phone (904) 222-2272

1000 Vintage Brunswick Cir
Ste 1
Brunswick, GA 31525
Phone (904) 222-2273

1601 Highway 40 E
Ste M151
Kingsland, GA 31548
Phone (904) 222-2273

Practitioners & affiliated clinicians

Practitioners 7

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": "1662336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747699200000",
    "number": "1790406148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "463688 STATE ROAD 200, STE 1",
            "address_2": "#364",
            "city": "YULEE",
            "state": "FL",
            "postal_code": "32097",
            "telephone_number": "478-290-0677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 RIVER HILLS DR STE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168980",
            "telephone_number": "904-222-2273",
            "fax_number": "904-902-8227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10752 Deerwood Park Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322564846",
            "country_code": "US",
            "telephone_number": "478-290-0677",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1601 Hwy 40 E Ste M-151",
            "address_purpose": "LOCATION",
            "city": "Kingsland",
            "state": "GA",
            "postal_code": "315486500",
            "country_code": "US",
            "telephone_number": "904-222-2273",
            "fax_number": "904-902-8227",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Vintage Brunswick Cir Ste 1",
            "address_purpose": "LOCATION",
            "city": "Brunswick",
            "state": "GA",
            "postal_code": "315251217",
            "country_code": "US",
            "telephone_number": "904-222-2273",
            "fax_number": "904-902-8227",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AT HOME PALLIATIVE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-05",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A",
        "authorized_official_last_name": "CISZEK",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "478-290-0677",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AT HOME PRIMARY CARE OF GEORGIA, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "At Home Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 20, 2025; 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.