NPIMap

Individual provider Active NPI

Shiva Mahinrad, M.D.

  • Internal Medicine Physician
  • Fleming Island, FL
National Provider Identifier
1922093095
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME92524 Issued in FL
Practice address
2310 Village Square Pkwy Ste 206
Fleming Island, FL 32003-6409
Phone
(904) 264-4405
Fax
(904) 391-5380
NPI assigned
Sep 15, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME92524 FL Primary

Addresses

Primary practice location

2310 Village Square Pkwy Ste 206
Fleming Island, FL 32003-6409

Mailing address

PO Box 746638
Atlanta, GA 30374-6638
Phone (904) 202-1032

Other practice location 1

2839 Henley Road
Green Cove Springs, FL 32043
Phone (904) 376-4950

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
I20050714000234 FL Practitioner - Internal MedicinePractitioner - Emergency Medicine 1759317472 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist Primary Care IncGroup PAC ID 0648177733, 459 clinicians

Practice addresses (Care Compare)

11236 Baptist Health Dr
Suite 220
Jacksonville, FL 32218-2988
Phone (904) 696-6900

Hospital & facility affiliations

  • Brooks Rehabilitation Home Health Home health agency, Jacksonville, FL, CCN 103174
  • Baptist Home Health Care by Bayada Home health agency, Jacksonville, FL, CCN 107482
  • Accentcare Home Health of Jacksonville Home health agency, Orange Park, FL, CCN 107725
  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • Ascension St Vincent'S Clay County Hospital, Middleburg, FL, CCN 100321
  • Ascension St Vincent'S Riverside Hospital, Jacksonville, FL, CCN 100040

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME92524FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Ambulatory Care Inc Internal Medicine CurrentSince Dec 1, 2015 Accepting new patients
Baptist Primary Care Inc Internal Medicine CurrentSince Aug 1, 2022 Accepting new patients
Baptist Primary Care Inc CurrentSince Aug 1, 2022 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Dec 1, 2015 Accepting new patients
Perry Emergency Physicians LLC Past Accepting new patients
Ipn Emergency Physicians of North Florida PA Past Accepting new patients
Premier Medical Clinic Internal Medicine Past Accepting new patients
DMH Emergency Physician Group, LLC Past Accepting new patients
North Florida Emergency Physicians Past Accepting new patients
Live Oak Hma Medical Group, LLC Past Accepting new patients

Locations

2310 Village Square Pkwy
Ste 206
Fleming Island, FL 32003
Phone (904) 264-4405

2839 Henley Rd
Green Cove Springs, FL 32043
Phone (904) 376-4950

836 Prudential Dr
Ste 1207
Jacksonville, FL 32207
Phone (904) 396-8656

11236 Baptist Health Dr
Ste 220
Jacksonville, FL 32218
Phone (904) 696-6900

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23008/brand/1/csg/1/fhir/r4
  • Direct secure messaging: shiva.mahinrad.1@8967.direct.athenahealth.com
  • Direct secure messaging: smahinrad113885@baptisthealthsystemjacksonville.direct-ci.com

Organizations & group practices 10

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 7

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": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1922093095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746638",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746638",
            "telephone_number": "904-202-1032",
            "fax_number": "904-376-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 VILLAGE SQUARE PKWY STE 206",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320036409",
            "telephone_number": "904-264-4405",
            "fax_number": "904-391-5380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2839 Henley Road",
            "address_purpose": "LOCATION",
            "city": "Green Cove Springs",
            "state": "FL",
            "postal_code": "32043",
            "country_code": "US",
            "telephone_number": "904-376-4950",
            "fax_number": "904-618-2183",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAHINRAD",
        "first_name": "SHIVA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-15",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME92524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fleming Island, FL

Sources for this page

Verify at the official NPI Registry.