NPIMap

Organization Active NPI

Integrative Psychiatric Solutions, LLC

Doing business as The Practice

  • Psychiatry Physician
  • Jacksonville, FL
National Provider Identifier
1942765300
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
INTEGRATIVE PSYCHIATRIC SOLUTIONS, LLC
Doing business as
The Practice
Practice address
3547 Hendricks Ave
Jacksonville, FL 32207-5309
Phone
(904) 877-1100
Fax
(904) 877-1200
NPI assigned
Feb 8, 2019
Last updated
Jul 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

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

Authorized official

Name
Mr. Charles B Maddix, APRN, MSN, PMHNP-BCNPI 1790047926
Title
President & Owner
Phone
(904) 877-1100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Addiction Medicine (Psychiatry & Neurology) Physician 2084A0401X NU
Psychiatry Physician 2084P0800X NU Primary
Child & Adolescent Psychiatry Physician 2084P0804X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU

Addresses

Primary practice location

3547 Hendricks Ave
Jacksonville, FL 32207-5309

Mailing address

3547 Hendricks Ave
Jacksonville, FL 32207-5309
Phone (904) 877-1100

Other practice location 1

2520 University Blvd W
Jacksonville, FL 32217-2004
Phone (904) 733-1444

Other names 1

  • The Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191023000540 FL Part B Supplier - Clinic/Group Practice 9133451271 Receives reassigned benefits from 3 practitioners
Practice locations: Jacksonville, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1549584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1942765300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3547 HENDRICKS AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075309",
            "telephone_number": "904-877-1100",
            "fax_number": "904-877-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3547 HENDRICKS AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075309",
            "telephone_number": "904-877-1100",
            "fax_number": "904-877-1200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2520 University Blvd W",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322172004",
            "country_code": "US",
            "telephone_number": "904-733-1444",
            "fax_number": "904-733-5258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTEGRATIVE PSYCHIATRIC SOLUTIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-08",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "MADDIX",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT & OWNER",
        "authorized_official_telephone_number": "904-877-1100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "APRN, MSN, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; 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.