Active NPI
Matthew G Paulus, A.T.
- Athletic Trainer
- Jacksonville, FL
National Provider Identifier
1871516401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL891
- Practice address
- 1325 San Marco Blvd
#102
Jacksonville, FL 32207-8568 - Phone
- (904) 858-7045
- Fax
- (904) 858-7047
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL891 | FL | Primary |
Addresses
Primary practice location
1325 San Marco Blvd
#102
Jacksonville, FL 32207-8568
Mailing address
1325 San Marco Blvd
Suite 701
Jacksonville, FL 32207-8568
Phone (904) 858-6418
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL891 | FL | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jacksonville Orthopaedic Institute Inc | Athletic Trainer | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Orthopaedic Surgery Physician
- Jacksonville, FL
- NPI 1346298023
Athletic Trainer
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871516401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1325 SAN MARCO BLVD",
"address_2": "SUITE 701",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322078568",
"telephone_number": "904-858-6418",
"fax_number": "904-858-6490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 SAN MARCO BLVD",
"address_2": "#102",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322078568",
"telephone_number": "904-858-7045",
"fax_number": "904-858-7047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAULUS",
"first_name": "MATTHEW",
"middle_name": "G",
"credential": "A.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL891",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.