Individual provider Active NPI

Kurt W Mori, MD

  • Diagnostic Radiology Physician
  • Jacksonville, FL
National Provider Identifier
1821058157
Registry record updated Aug 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
ME36779 Issued in FL
Practice address
3599 University Blvd S
Building 300
Jacksonville, FL 32216-4252
Phone
(904) 399-5550
Fax
(904) 346-4334
NPI assigned
Mar 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X ME36779 FL
Diagnostic Radiology Physician 2085R0202X ME36779 FL Primary

Addresses

Primary practice location

3599 University Blvd S
Building 300
Jacksonville, FL 32216-4252

Mailing address

3599 University Blvd S
Building 300
Jacksonville, FL 32216-4252
Phone (904) 399-5550

Other identifiers 3

IdentifierTypeStateIssuer
047706100MedicaidFL
00356243AMedicaidGA
15714OtherFLBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME36779FLMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mori Bean and Brooks Inc Diagnostic Radiology CurrentSince Jul 1, 1980 Accepting new patients
Northside Imaging LLC Diagnostic Radiology PastSince Aug 1, 2020 Accepting new patients
Imaging Services of Jacksonville LLC Diagnostic Radiology Past Accepting new patients

Locations

8375 Dix Ellis Trl
Ste 201
Jacksonville, FL 32256
Phone (904) 399-5810

3599 University Blvd S
Ste 300
Jacksonville, FL 32216
Phone (904) 348-3879

836 Prudential Dr
Ste 105
Jacksonville, FL 32207
Phone (904) 202-2901

800 Prudential Dr
Jacksonville, FL 32207
Phone (904) 202-2000

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

1900 Tebeau St
Waycross, GA 31501
Phone (912) 283-3030

1900 Tebeau St
Ste C
Waycross, GA 31501

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503360000000",
    "number": "1821058157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3599 UNIVERSITY BLVD S",
            "address_2": "BUILDING 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164252",
            "telephone_number": "904-399-5550",
            "fax_number": "904-346-4334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3599 UNIVERSITY BLVD S",
            "address_2": "BUILDING 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164252",
            "telephone_number": "904-399-5550",
            "fax_number": "904-346-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORI",
        "first_name": "KURT",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2017-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "FL",
            "license": "ME36779",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME36779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047706100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00356243A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "15714",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.