NPIMap

Individual provider Active NPI

Victor A Maquera, MD

  • Neurology Physician
  • Orange Park, FL
National Provider Identifier
1891786059
Registry record updated Jan 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
ME59449 Issued in FL
Practice address
1895 Kingsley Ave
Ste 903
Orange Park, FL 32073-4466
Phone
(904) 276-1663
Fax
(904) 276-2469
NPI assigned
Nov 4, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X ME59449 FL Primary

Addresses

Primary practice location

1895 Kingsley Ave
Ste 903
Orange Park, FL 32073-4466

Mailing address

PO Box 17809
Jacksonville, FL 32245-7809
Phone (904) 723-5665

Other identifiers 3

IdentifierTypeStateIssuer
1891786059OtherFLNPI
379665500MedicaidFL
130013419OtherFLRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100308000384 FL Practitioner - Neurology 5193777050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1202 Kingsley Ave
Orange Park, FL 32073-4632
Phone (904) 276-1663

Hospital & facility affiliations

  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • Ascension St Vincent'S Riverside Hospital, Jacksonville, FL, CCN 100040
  • Ascension St Vincent'S Clay County Hospital, Middleburg, FL, CCN 100321
  • Brooks Rehabilitation Hospital University Campus Inpatient rehabilitation facility, Jacksonville, FL, CCN 103039

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Neurotek Inc Neurology CurrentSince May 1, 2014 Accepting new patients
Dennis D. Dewey, M.D., P.a. Neurology PastSince Jan 1, 2010 Accepting new patients
Jacksonville Neurological Clinic, P.a. Past Accepting new patients
Medical Neurodiagnostics & Neurology PL PastSince May 2, 2010 Accepting new patients

Locations

1202 Kingsley Ave
Orange Park, FL 32073
Phone (904) 276-1663

1210 Kingsley Ave
Ste 1
Orange Park, FL 32073
Phone (904) 276-1663

Organizations & group practices 4

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294272000000",
    "number": "1891786059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17809",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322457809",
            "telephone_number": "904-723-5665",
            "fax_number": "904-338-0951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1895 KINGSLEY AVE",
            "address_2": "STE 903",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734466",
            "telephone_number": "904-276-1663",
            "fax_number": "904-276-2469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAQUERA",
        "first_name": "VICTOR",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-04",
        "last_updated": "2011-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME59449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1891786059",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "379665500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "130013419",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.