NPIMap

Organization Active NPI

DRS Baker & Gilmour MD PA

  • Cardiovascular Disease Physician
  • Jacksonville, FL
National Provider Identifier
1962555490
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
DRS BAKER & GILMOUR MD PA
Practice address
12276 San Jose Blvd
Suite 617
Jacksonville, FL 32223-8628
Phone
(904) 880-0025
NPI assigned
Jan 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

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

Authorized official

Name
Mr. Jody Bostic
Title
Practice Administrator
Phone
(904) 733-4444

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X

Addresses

Primary practice location

12276 San Jose Blvd
Suite 617
Jacksonville, FL 32223-8628

Mailing address

3550 University Blvd S
Suite 302
Jacksonville, FL 32216-4246
Phone (904) 733-4444

Other identifiers 3

IdentifierTypeStateIssuer
252952100MedicaidFL
77241OtherFLBCBS
CB1978OtherFLRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031217001068 FL Part B Supplier - Clinic/Group Practice 5193622058 Receives reassigned benefits from 6 practitioners
3 other NPIs on this enrollment
Practice locations: St Augustine, FL; Jacksonville, FL

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
DRS Baker Gilmour MD PA4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

11701 San Jose Blvd
Ste 106
Jacksonville, FL 32223
Phone (904) 880-0025

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1962555490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 UNIVERSITY BLVD S",
            "address_2": "SUITE 302",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164246",
            "telephone_number": "904-733-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12276 SAN JOSE BLVD",
            "address_2": "SUITE 617",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238628",
            "telephone_number": "904-880-0025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS BAKER & GILMOUR MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "BOSTIC",
        "authorized_official_first_name": "JODY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "904-733-4444",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252952100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "77241",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB1978",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Sep 1, 2016; 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.