NPIMap

Organization Active NPI

Florida Physician Specialists LLC

Doing business as Urology Associates of Northeast Florida

  • Urology Physician
  • Orange Park, FL
National Provider Identifier
1932444254
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
ME59868 Issued in FL
Legal business name
FLORIDA PHYSICIAN SPECIALISTS LLC
Doing business as
Urology Associates of Northeast Florida
Practice address
1715 Village Way
Orange Park, FL 32073-5263
Phone
(904) 264-8418
Fax
(904) 264-9692
NPI assigned
Nov 28, 2012
Last updated
Nov 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

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

Authorized official

Name
Dr. Mitchell D. Terk, MD
Title
Authorized Official
Phone
(904) 309-8680

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X ME59868 FL Primary

Addresses

Primary practice location

1715 Village Way
Orange Park, FL 32073-5263

Mailing address

3599 University Blvd S
Suite 805
Jacksonville, FL 32216-4252
Phone (904) 309-8680

Other names 1

  • Urology Associates of Northeast Florida Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121130000298 FL Part B Supplier - Clinic/Group Practice 4486806213 Receives reassigned benefits from 53 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jacksonville, FL; Orange Park, FL; Jacksonville Beach, FL

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Florida Physician Specialists LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1715 Village Way
Orange Park, FL 32073
Phone (904) 264-8418

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1354060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1932444254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3599 UNIVERSITY BLVD S",
            "address_2": "SUITE 805",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164252",
            "telephone_number": "904-309-8680",
            "fax_number": "904-345-5841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 VILLAGE WAY",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735263",
            "telephone_number": "904-264-8418",
            "fax_number": "904-264-9692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA PHYSICIAN SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-28",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "TERK",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "904-309-8680",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "FL",
            "license": "ME59868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Urology Associates of Northeast Florida",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; 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.