Orthotic & Prosthetic Clinic of Jacksonville, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

ORTHOTIC & PROSTHETIC CLINIC OF JACKSONVILLE, LLC

Practice address

11512 Lake Mead Ave Unit 404
Jacksonville, FL 32256-9687

Phone

(904) 231-8440

Fax

(904) 231-8441

NPI assigned

Mar 5, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Rafael Agustin Diaz Abreu

Title

Owner / Ambr

Phone

(305) 812-5087

Specialties & licenses 2

Addresses

Other names 1

• ORTHOTIC & PROSTHETIC CLINICS OF AMERICA Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1709596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1942067939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2754 NW 27TH AVE",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334343692",
            "telephone_number": "305-812-5087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE UNIT 404",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569687",
            "telephone_number": "904-231-8440",
            "fax_number": "904-231-8441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOTIC & PROSTHETIC CLINIC OF JACKSONVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-05",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "DIAZ ABREU",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_middle_name": "AGUSTIN",
        "authorized_official_title_or_position": "OWNER / AMBR",
        "authorized_official_telephone_number": "305-812-5087",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ORTHOTIC & PROSTHETIC CLINICS OF AMERICA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.