Organization Active NPI

Synergy Health Group LLC

  • Cardiovascular Disease Physician
  • Jacksonville, FL
National Provider Identifier
1891294856
Registry record updated Aug 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
ME90169 Issued in FL
Legal business name
SYNERGY HEALTH GROUP LLC
Practice address
7828 Collins Grove Rd
Jacksonville, FL 32256
Phone
(904) 721-0894
Fax
(904) 721-9449
NPI assigned
Feb 6, 2018
Organization subpart
Yes
Parent organization
SYNERGY HEALTH GROUP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 8, 2018

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

Authorized official

Name
Crystal Hall
Title
Practice Adminsitrator
Phone
(904) 721-0894

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X ME90169 FL Primary
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X ME97437 FL

Addresses

Primary practice location

7828 Collins Grove Rd
Jacksonville, FL 32256

Mailing address

2735 University Blvd S
Jacksonville, FL 32216-2548
Phone (904) 721-0849

Other identifiers 2

IdentifierTypeStateIssuer
278421100MedicaidFL
18799100MedicaidFL

Other names 1

  • Synergy Lifestyle Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181030000557 FL Part B Supplier - Intensive Cardiac Rehabilitation 3678836160 Receives reassigned benefits from 2 practitioners
Practice locations: Jacksonville, FL

National Provider Directory

National Provider Directory
Part of
Synergy Health Group LLC

Locations

5737 Barnhill Dr
Jacksonville, FL 32207
Phone (904) 422-9563

5737 Barnhill Dr
Ste 200
Jacksonville, FL 32207

5737 Barnhill Dr
Ste 100
Jacksonville, FL 32207

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1517875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533686400000",
    "number": "1891294856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2735 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162548",
            "telephone_number": "904-721-0849",
            "fax_number": "904-721-9449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7828 COLLINS GROVE RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "904-721-0894",
            "fax_number": "904-721-9449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYNERGY HEALTH GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SYNERGY HEALTH GROUP LLC",
        "enumeration_date": "2018-02-06",
        "last_updated": "2018-08-08",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "PRACTICE ADMINSITRATOR",
        "authorized_official_telephone_number": "904-721-0894"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME90169",
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "FL",
            "license": "ME97437",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278421100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18799100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Synergy Lifestyle Center",
            "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 Aug 8, 2018; 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.