Individual provider Active NPI

Jeremy Carlson

  • Nephrology Physician
  • Jacksonville, FL
National Provider Identifier
1932562832
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
750803 Issued in FL
Practice address
655 W 8TH St
Jacksonville, FL 32209-6511
Phone
(904) 244-0411
NPI assigned
Mar 30, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 750803 FL Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

655 W 8TH St
Jacksonville, FL 32209-6511

Mailing address

1600 SW Archer Rd
Gainesville, FL 32610-3003
Phone (352) 265-4845

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
I20210503001739 FL Practitioner - Internal Medicine 8527347921 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Florida College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nephrology Consultants of Jax LLCGroup PAC ID 0840737953, 4 clinicians

Practice addresses (Care Compare)

3129 Hendricks Ave
Suite 2
Jacksonville, FL 32207-4217
Phone (904) 398-8266

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
750803FLMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Consultants of Jacksonville LLC Nephrology CurrentSince May 1, 2021 Accepting new patients
Nephrology Consultants of Jax LLC Nephrology CurrentSince Apr 1, 2026 Accepting new patients

Locations

11705 San Jose Blvd
Ste 106
Jacksonville, FL 32223
Phone (904) 619-4942

3129 Hendricks Ave
Ste 2
Jacksonville, FL 32207
Phone (904) 398-8266

3129 Hendricks Ave
Jacksonville, FL 32207
Phone (904) 398-8266

10337 San Jose Blvd
Ste 104
Jacksonville, FL 32257
Phone (904) 268-7701

11513 N Main St
Jacksonville, FL 32218
Phone (904) 751-6200

1633 Church St
Ste 500
Nashville, TN 37203
Phone (615) 327-3061

Organizations & group practices 2

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 5

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": "1459296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1932562832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326103003",
            "telephone_number": "352-265-4845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W 8TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-244-0411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "JEREMY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-30",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "750803",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.