Jacksonville Internal Medicine

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25404 Issued in AL

Legal business name

JACKSONVILLE INTERNAL MEDICINE

Practice address

2270 Pelham Rd S
Jacksonville, AL 36265-9582

Phone

(256) 435-5499

Fax

(256) 435-6064

NPI assigned

Nov 8, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Rey GavinoNPI 1659457794

Title

Owner

Phone

(256) 435-5499

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Tax ID family

Jacksonville Intermed Assoc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Jacksonville Internal Medicine

  • Internal Medicine Physician
  • Gadsden, AL
  • NPI 1013093152
  NPD tax ID

Locations

Practitioners 4

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

• Rey S Gavino, M.D.

  • Internal Medicine Physician
  • Gadsden, AL
  • NPI 1659457794
  Medicare reassignment NPD Authorized official
• Joy Gavino

  • Internal Medicine Physician
  • Piedmont, AL
  • NPI 1003992157
  Medicare reassignment NPD
• William C Jordan

  • Mental Health Counselor
  • Rome, GA
  • NPI 1720099518
  NPD (past)
• Dorothy Karen Nelder, M.D.

  • Family Medicine Physician
  • Jesup, GA
  • NPI 1285695338
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326240000000",
    "number": "1811066103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "36265",
            "telephone_number": "256-435-5499",
            "fax_number": "256-435-6064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2270 PELHAM RD S",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362659582",
            "telephone_number": "256-435-5499",
            "fax_number": "256-435-6064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2012-01-11",
        "status": "A",
        "authorized_official_last_name": "GAVINO",
        "authorized_official_first_name": "REY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-435-5499",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "25404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "01D1017203",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529917260",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacksonville Anesthesia LLC
• Jacksonville Aristo ER, LLC
• Jacksonville City
• Jacksonville Emergency Physicians LLC
• Jacksonville Health and Rehabilitation, LLC
• Jacksonville Medical Professional Services LLC
• Jacksonville State University
• Jacksonville Surgical & Medical Affiliates, LLC
• Jennifer Woodard CRNP
• Johnson RX Inc

• Internal Medicine Physician in Jacksonville, AL
• Providers in Jacksonville, AL by specialty
• Internal Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; 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.