NPIMap

Organization Active NPI

Jacksonville Lung Clinic LLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Jacksonville Beach, FL
National Provider Identifier
1861991937
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
Legal business name
JACKSONVILLE LUNG CLINIC LLC
Practice address
1350 13TH Ave S
Jacksonville Beach, FL 32250-3203
Phone
(904) 627-2900
Fax
(904) 253-3098
NPI assigned
Feb 5, 2018
Last updated
Jan 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Authorized official

Name
Chad Pew
Title
Vice President
Phone
(307) 262-9410

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X NU Primary
Pulmonary Disease Physician 207RP1001X NU

Addresses

Primary practice location

1350 13TH Ave S
Jacksonville Beach, FL 32250-3203

Mailing address

7500 Rialto Blvd
Austin, TX 78735-8531
Phone (512) 730-3060

Other practice location 1

7500 Rialto Blvd Ste 1-140
Austin, TX 78735
Phone (512) 730-3060

Other identifiers 1

IdentifierTypeStateIssuer
022274400MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180705002822 FL Part B Supplier - Clinic/Group Practice 4486900412 Receives reassigned benefits from 28 practitioners
Practice locations: Jacksonville Beach, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1517788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1861991937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7500 RIALTO BLVD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787358531",
            "telephone_number": "512-730-3060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 13TH AVE S",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503203",
            "telephone_number": "904-627-2900",
            "fax_number": "904-253-3098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7500 Rialto Blvd Ste 1-140",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "78735",
            "country_code": "US",
            "telephone_number": "512-730-3060",
            "fax_number": "888-730-1925",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JACKSONVILLE LUNG CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-05",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A",
        "authorized_official_last_name": "PEW",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "307-262-9410"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022274400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; 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.