NPIMap

Organization Active NPI

Memorial Neurosurgery Group LLC

  • Neurological Surgery Physician
  • Jacksonville, FL
National Provider Identifier
1811927650
Registry record updated Nov 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
MEMORIAL NEUROSURGERY GROUP LLC
Doing business as
Memorial Neurosurgery Group, LLC
Practice address
4063 Salisbury Rd
Suite 210
Jacksonville, FL 32216-8030
Phone
(904) 296-2522
Fax
(904) 296-8173
NPI assigned
Jul 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2007

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

Authorized official

Name
Mickey Pickler
Title
Vice President
Phone
(850) 523-2117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X Primary

Addresses

Primary practice location

4063 Salisbury Rd
Suite 210
Jacksonville, FL 32216-8030

Mailing address

4063 Salisbury Rd
Suite 210
Jacksonville, FL 32216-8030
Phone (904) 296-2522

Other names 1

  • Memorial Neurosurgery Group, LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070717000593 FL Part B Supplier - Clinic/Group Practice 9537261185 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Orange Park, FL; Ocala, FL; Miami, FL; Jacksonville, FL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1731 University Blvd S
Jacksonville, FL 32216
Phone (904) 725-0200

4063 Salisbury Rd
Ste 210
Jacksonville, FL 32216
Phone (919) 247-2450

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193961600000",
    "number": "1811927650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4063 SALISBURY RD",
            "address_2": "SUITE 210",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168030",
            "telephone_number": "904-296-2522",
            "fax_number": "904-296-8173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4063 SALISBURY RD",
            "address_2": "SUITE 210",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168030",
            "telephone_number": "904-296-2522",
            "fax_number": "904-296-8173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL NEUROSURGERY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2007-11-02",
        "status": "A",
        "authorized_official_last_name": "PICKLER",
        "authorized_official_first_name": "MICKEY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "850-523-2117"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Neurosurgery Group, LLC",
            "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 Nov 2, 2007; 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.