NPIMap

Organization Active NPI

Medfund LLC

Doing business as Horizon St. Augustine LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • St Augustine, FL
National Provider Identifier
1841293982
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
License
HCC5205 Issued in FL
Legal business name
MEDFUND LLC
Doing business as
Horizon St. Augustine LLC
Practice address
200 Southpark Blvd
Ste 210
St Augustine, FL 32086-3101
Phone
(904) 819-0920
Fax
(904) 819-0299
NPI assigned
May 23, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Martin J Kern
Title
Senior Vice President
Phone
(941) 925-3490

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X HCC5205 FL Primary

Addresses

Primary practice location

200 Southpark Blvd
Ste 210
St Augustine, FL 32086-3101

Mailing address

240 N Washington Blvd
Sarasota, FL 34236-5945
Phone (941) 925-3490

Other identifiers 4

IdentifierTypeStateIssuer
2302684OtherAETNA HMO #
V2456OtherFLBCBS PROVIDER #
7008104OtherAETNA PPO/POS #
105715-15OtherFLCITRUS HMO

Other names 1

  • Horizon St. Augustine LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Horizon MRI of Lewisville LLC17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Locations

3020 S Harvard Ave
Tulsa, OK 74114
Phone (918) 324-3100

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841293982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 N WASHINGTON BLVD",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342365945",
            "telephone_number": "941-925-3490",
            "fax_number": "941-953-4452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SOUTHPARK BLVD",
            "address_2": "STE 210",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320863101",
            "telephone_number": "904-819-0920",
            "fax_number": "904-819-0299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDFUND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KERN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "941-925-3490",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "FL",
            "license": "HCC5205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO #",
            "identifier": "2302684",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "V2456",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO/POS #",
            "identifier": "7008104",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CITRUS HMO",
            "identifier": "105715-15",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Horizon St. Augustine LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.