John Knox Village of Central Florida Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH28802 Issued in FL

Legal business name

JOHN KNOX VILLAGE OF CENTRAL FLORIDA INC

Practice address

701 Monastery Rd Ste a
Orange City, FL 32763-6222

Phone

(386) 456-1500

Fax

(385) 456-1551

NPI assigned

Jan 22, 2015

Organization subpart

No

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

Authorized official

Name

Paul Skelton

Title

Pharmacy Director

Phone

(386) 456-1500

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Oak Park Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• John Knox Village of Central Florida Inc

  • Long Term Care Pharmacy
  • Orange City, FL
  • NPI 1386033736

  O20150706000804

  Same enrollment

Tax ID family

Oak Park Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• John Knox Village of Central Florida Inc

  • Long Term Care Pharmacy
  • Orange City, FL
  • NPI 1386033736
  NPD tax ID
• John Knox Village of Central Florida, Inc

  • Home Health Agency
  • Orange City, FL
  • NPI 1346584828
  NPD tax ID
• John Knox Village of Central Florida, Inc

  • Primary Care Nurse Practitioner
  • Orange City, FL
  • NPI 1861263147
  NPD tax ID

Locations

Networks

• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

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

{
    "created_epoch": "1421884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474416000000",
    "number": "1902295355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 MONASTERY RD",
            "address_2": "SUITE A",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327636222",
            "telephone_number": "386-456-1500",
            "fax_number": "385-456-1551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 MONASTERY RD STE A",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327636222",
            "telephone_number": "386-456-1500",
            "fax_number": "385-456-1551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN KNOX VILLAGE OF CENTRAL FLORIDA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-22",
        "last_updated": "2016-09-21",
        "status": "A",
        "authorized_official_last_name": "SKELTON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "386-456-1500"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH28802",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014310400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2149639",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oak Park Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emily Jessup, BCBA
• Jessup, Inc
• Jose Alberto Jimenez
• James M Jochum, MD
• John Knox Village of Central Florida Inc
• John Knox Village of Central Florida, Inc
• John Knox Village of Central Florida, Inc
• John Knox Village of Central Florida, Inc
• Heather Johns
• Caleigh Johnson

• Community/Retail Pharmacy in Orange City, FL
• Providers in Orange City, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; 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.