NPIMap

Individual provider Active NPI

Jason Jacob Skiwski, M.D.

  • Pediatrics Physician
  • Daytona Beach, FL
National Provider Identifier
1992715130
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME163346 Issued in FL
Practice address
301 Memorial Medical Pkwy
Daytona Beach, FL 32117-5167
Phone
(407) 975-0410
Fax
(407) 975-0407
NPI assigned
Aug 9, 2006
Last updated
Nov 20, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 64973 GA
Pediatrics Physician 208000000X ME163346 FL Primary

Addresses

Primary practice location

301 Memorial Medical Pkwy
Daytona Beach, FL 32117-5167

Mailing address

PO Box 12938
C/O Clinic Management
Calhoun, GA 30703-7013

Other practice location 1

815 Curtis Pkwy SE
Calhoun, GA 30701-3688
Phone (706) 879-5800

Other identifiers 1

IdentifierTypeStateIssuer
263645644GMedicaidGA

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
I20231027000373 FL Practitioner - Pediatric Medicine 6507141405 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
64973GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Pediatrics CurrentSince Nov 6, 2023 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Nov 6, 2023 Accepting new patients
Agc Pediatrics, LLC PastSince Sep 23, 2019 Accepting new patients
Central Georiga Fertility Institute Past Accepting new patients
Adventist Health System Georgia Inc Past Accepting new patients
Adventist Health System Georgia Inc PastSince Jun 1, 2020 Accepting new patients
Adventist Health System Georgia, Inc. Past Accepting new patients
Agc Pediatrics, LLC Past Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DEJAAA
  • Direct secure messaging: jskiwski661800@adventhealth.direct-ci.com

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1992715130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12938",
            "address_2": "C/O CLINIC MANAGEMENT",
            "city": "CALHOUN",
            "state": "GA",
            "postal_code": "307037013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MEMORIAL MEDICAL PKWY",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175167",
            "telephone_number": "407-975-0410",
            "fax_number": "407-975-0407"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "815 Curtis Pkwy SE",
            "address_purpose": "LOCATION",
            "city": "Calhoun",
            "state": "GA",
            "postal_code": "307013688",
            "country_code": "US",
            "telephone_number": "706-879-5800",
            "fax_number": "706-625-3207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SKIWSKI",
        "first_name": "JASON",
        "middle_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "64973",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME163346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "263645644G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.