First Coast Orthopedic Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

FIRST COAST ORTHOPEDIC CENTER, LLC

Doing business as

First Coast Surgery Center

Practice address

4035 Southpoint Boulevard
Jacksonville, FL 32216

Phone

(904) 507-6077

NPI assigned

Sep 5, 2019

Organization subpart

No

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

Authorized official

Name

Kashondra Smith

Title

Chief Administrative Officer

Phone

(904) 507-6047

Specialties & licenses 1

Addresses

Other names 1

• First Coast Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Listed as

First Coast Orthopedic Center LLCCCN 10C0001664

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1567641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619481600000",
    "number": "1811546575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4035 SOUTHPOINT BOULEVARD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 SOUTHPOINT BOULEVARD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32216",
            "telephone_number": "904-507-6077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST COAST ORTHOPEDIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-05",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KASHONDRA",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "904-507-6047"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "First Coast Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "First Coast Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• First Coast Medical Center Inc
• First Coast Medicine PLLC
• First Coast Midwifery Services LLC
• First Coast Nephrology Inc
• First Coast Orthopedic Associates LLC
• First Coast Pathology Associates, LLC
• First Coast Periodontics, PA
• First Coast Physical Medicine Inc
• First Coast Plastic Surgery PA
• First Coast Podiatric Surgery and Wound Care LLC

• Ambulatory Surgical Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.