NPIMap

Individual provider Active NPI

Craig A Dolven, DO

  • Family Medicine Physician
  • Orange Park, FL
National Provider Identifier
1962504787
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101009987 Issued in MI
Practice address
1825 Kingsley Ave Ste 200
Orange Park, FL 32073-4484
Phone
(904) 264-8621
Fax
(904) 215-9418
NPI assigned
Sep 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101009987 MI Primary

Addresses

Primary practice location

1825 Kingsley Ave Ste 200
Orange Park, FL 32073-4484

Mailing address

1594 Kingsley Ave
Orange Park, FL 32073-4546
Phone (904) 264-8621

Other identifiers 2

IdentifierTypeStateIssuer
015808300MedicaidFL
3235477MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address CRAIG.DOLVEN@hca5.eclinicaldirectplus.com

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
I20160202002210 FL Practitioner - Family Practice 4385787878 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorial Family Practice Associates, LLCGroup PAC ID 8820003411, 50 clinicians

Practice addresses (Care Compare)

1594 Kingsley Ave
Orange Park, FL 32073-4546
Phone (904) 264-8621

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.15 of 100Reported as individual
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101009987MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Family Practice Associates, LLC Family Medicine CurrentSince Nov 1, 2015 Accepting new patients
Genesys Integrated Group Practice PC Past Accepting new patients
Memorial Family Practice Associates LLC Family Medicine PastSince Feb 25, 2024 Accepting new patients

Locations

1731 University Blvd S
Jacksonville, FL 32216
Phone (904) 725-0200

1594 Kingsley Ave
Orange Park, FL 32073
Phone (904) 264-8621

1825 Kingsley Ave
Ste 200
Orange Park, FL 32073
Phone (904) 264-8621

Interoperability endpoints

  • Direct secure messaging: craig.dolven@hca5.eclinicaldirectplus.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1962504787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1594 KINGSLEY AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734546",
            "telephone_number": "904-264-8621",
            "fax_number": "904-215-9418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 KINGSLEY AVE STE 200",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734484",
            "telephone_number": "904-264-8621",
            "fax_number": "904-215-9418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOLVEN",
        "first_name": "CRAIG",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-02",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101009987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015808300",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3235477",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CRAIG.DOLVEN@hca5.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "1594 Kingsley Ave",
            "city": "Orange Park",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320734546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.