NPIMap

Organization Active NPI

Florida Proton Therapy Institute Inc

  • Radiation Oncology Physician
  • Jacksonville, FL
National Provider Identifier
1891748257
Registry record updated Dec 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
ME39054 Issued in FL
Legal business name
FLORIDA PROTON THERAPY INSTITUTE INC
Practice address
2015 Jefferson St
Jacksonville, FL 32206-3531
Phone
(904) 588-1263
Fax
(904) 588-1300
NPI assigned
May 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2024

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

Authorized official

Name
Nancy Medenhall, MD
Title
Director, Active, Attending
Phone
(904) 588-1401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0001X ME39054 FL Primary

Addresses

Primary practice location

2015 Jefferson St
Jacksonville, FL 32206-3531

Mailing address

2015 Jefferson St
Jacksonville, FL 32206-3531
Phone (904) 588-1401

Other identifiers 1

IdentifierTypeStateIssuer
2771470 00MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150226001684 FL Part B Supplier - Clinic/Group Practice 0749285609 Receives reassigned benefits from 12 practitioners
Practice locations: Jacksonville, FL

National Provider Directory

National Provider Directory

Locations

15255 Max Leggett Pkwy
Ste 4400
Jacksonville, FL 32218
Phone (904) 383-1000

4549 Emerson St
Fl 2
Jacksonville, FL 32207

655 W 8th St
Fl 2
Jacksonville, FL 32209
Phone (904) 244-4202

Practitioners & affiliated clinicians

Practitioners 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733356800000",
    "number": "1891748257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 JEFFERSON ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322063531",
            "telephone_number": "904-588-1401",
            "fax_number": "904-588-1437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 JEFFERSON ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322063531",
            "telephone_number": "904-588-1263",
            "fax_number": "904-588-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA PROTON THERAPY INSTITUTE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A",
        "authorized_official_last_name": "MEDENHALL",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "DIRECTOR, ACTIVE, ATTENDING",
        "authorized_official_telephone_number": "904-588-1401",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": "FL",
            "license": "ME39054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2771470 00",
            "state": "FL"
        }
    ],
    "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 Dec 5, 2024; 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.