Jacksonville Beaches Medical Imaging Inc

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

HCCR1416 Issued in FL

Legal business name

JACKSONVILLE BEACHES MEDICAL IMAGING INC

Practice address

3316 3Rd St S
Suite 101
Jacksonville Beach, FL 32250-6073

Phone

(904) 241-7772

Fax

(904) 241-7702

NPI assigned

Sep 29, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Cathy Blaese

Title

Chief Operating Officer

Phone

(904) 241-7772

Specialties & licenses 1

Addresses

Other identifiers 5

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349136000000",
    "number": "1801883582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3316 3RD ST S",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322506073",
            "telephone_number": "904-241-7772",
            "fax_number": "904-241-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3316 3RD ST S",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322506073",
            "telephone_number": "904-241-7772",
            "fax_number": "904-241-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE BEACHES MEDICAL IMAGING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2012-10-02",
        "status": "A",
        "authorized_official_last_name": "BLAESE",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "904-241-7772",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "FL",
            "license": "HCCR1416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH ID",
            "identifier": "1840590",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH CARE CLINIC REG",
            "identifier": "1416",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "470001169",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "V2405",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1ST HEALTH W/C ID",
            "identifier": "147878900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sherri K Jackson, APRN
• Wesley Alexander Jackson
• Jacksonville Acupuncture Wellness, PA
• Jacksonville Beach Surgery Center, LLC (Jacksonville Beach Surgery Center)
• Jacksonville Beaches Anesthesia Associates, Inc.
• Jacksonville Lung Clinic LLC
• Jacksonville Orthopaedic Institute Inc
• Jacksonville Orthopaedic Institute Inc
• Jacksonville Orthopaedic Institute Inc
• Joshua Lawrence Jaeger, PA-C

• Radiology Clinic/Center in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Radiology Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.