Individual provider Active NPI

Gene Ashley Harris, D.O.

  • Family Medicine Physician
  • Fleming Island, FL
National Provider Identifier
1912926700
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS6100 Issued in FL
Practice address
1689 Eagle Harbor Pkwy Ste a
Fleming Island, FL 32003-4817
Phone
(904) 269-1366
Fax
(904) 264-9750
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS6100 FL Primary

Addresses

Primary practice location

1689 Eagle Harbor Pkwy Ste a
Fleming Island, FL 32003-4817

Mailing address

705 Wells Rd Ste 300
Orange Park, FL 32073-2982
Phone (904) 282-6331

Other identifiers 1

IdentifierTypeStateIssuer
053649100MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100205000533 FL Practitioner - Family Practice 5092612333 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Group Services PA Family Medicine Current Accepting new patients
Physicians Group Services PA CurrentSince Sep 1, 1999 Accepting new patients
Physicians Group Services PA Family Medicine CurrentSince Sep 1, 1999 Accepting new patients

Locations

1906 Southside Blvd
Jacksonville, FL 32216
Phone (904) 724-3083

7855 Argyle Forest Blvd
Ste 101
Jacksonville, FL 32244

1909 Beach Blvd
Ste 102
Jax Bch, FL 32250
Phone (904) 246-2752

3839 County Road 218
Middleburg, FL 32068
Phone (904) 282-5474

1689 Eagle Harbor Pkwy
Ste A
Orange Park, FL 32003
Phone (904) 269-1366

1409 Kingsley Ave
Ste 6A
Orange Park, FL 32073
Phone (904) 264-7517

705 Wells Rd
#300
Orange Park, FL 32073
Phone (904) 282-5474

205 Zeagler Dr
Ste 203
Palatka, FL 32177
Phone (386) 312-8519

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1912926700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 WELLS RD STE 300",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320732982",
            "telephone_number": "904-282-6331",
            "fax_number": "904-619-1080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1689 EAGLE HARBOR PKWY STE A",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320034817",
            "telephone_number": "904-269-1366",
            "fax_number": "904-264-9750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "GENE",
        "middle_name": "ASHLEY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS6100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053649100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fleming Island, FL

Sources for this page

Verify at the official NPI Registry.