PHYSICIAN GROUP HOLDINGS, LLC (NPI# 1003478827) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003478827 |
| Entity Type | Organization |
| Organization Name | PHYSICIAN GROUP HOLDINGS, LLC |
| Practice Address |
10210 San Jose Blvd Ste 4 Jacksonville FL 32257-6271 |
| Practice Telephone | 9049908484 |
| Practice Fax Number | 9049908485 |
| Mailing Telephone | 9049908484 |
| Mailing Fax Number | 9049908485 |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2019-07-01 |
| Authorized Official Name | DR. MEGAN ELIZABETH DEACON-CASEY (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 9049908484 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Ageless Vein Center | Doing Business As Name - Organization |
| Street Address |
10210 SAN JOSE BLVD STE 4 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32257-6271 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437178928 | Joni Collins Ricketts | Physician Assistant | 10210 San Jose Blvd Ste 4, Jacksonville, FL 32257-6271 | 2006-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740835842 | Majdoline Kasera | Pharmacist | 11250-4 Old St Augustine Rd, Jacksonville, FL 32257 | 2019-08-06 |
| 1386203859 | Jetaime Y Lewis | Physical Therapist | 9765 San Jose Blvd Ste 6, Jacksonville, FL 32257 | 2019-06-10 |
| 1437622107 | Michelle Espanol Garcia | Nurse Practitioner | 9957 Moorings Dr Ste 204, Jacksonville, FL 32257 | 2019-01-05 |
| 1982172995 | Pacifica Augustine Road LLC | Alzheimer Center (Dementia Center) | 10660 Old Augustine Road, Jacksonville, FL 32257 | 2018-11-07 |
| 1659860492 | Andrea Leigh Miller | Social Worker | 10416 Spotted Fawn Lane, Jacksonville, FL 32257 | 2018-05-08 |
| 1376049965 | Stephanie Lynne Jordon | Nurse Practitioner | 9765 San Jose Blvd Ste 102, Jacksonville, FL 32257 | 2018-04-02 |
| 1205335619 | Annetta Aileen Brown | Respite Care | 4901 Sunbeam Rd Apt 1016, Jacksonville, FL 32257 | 2018-02-12 |
| 1841714888 | Freda Stevens | Counselor | 9521 Shellie Road Unit 13, Jacksonville, FL 32257 | 2017-08-01 |
| 1659821353 | Jennifer Lavoro | Acupuncturist | 11259 Thomaston Pl, Jacksonville, FL 32257 | 2016-10-06 |
| 1225488232 | Avenues Dental LLC | Dentist | 6144 Gazebo Park Place South, Ste 210, Jacksonville, FL 32257 | 2016-06-21 |
| Find all providers in zip 32257 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972681542 | Kok L. Chong | Radiology | 800 Lomax St, Suite 100a, Jacksonville, FL 32204-3927 | 2006-11-01 |
| 1730189739 | James K St George | Radiology | 8767 Perimeter Park Blvd, Jacksonville, FL 32216-5479 | 2005-08-01 |
| 1992294938 | Christopher Gammarano | Radiology | 4500 San Pablo Rd S, Jacksonville, FL 32224 | 2018-05-04 |
| 1457770604 | Jehan L Shah | Radiology | 4500 San Pablo Rd S, Jacksonville, FL 32224 | 2014-04-15 |
| 1184069411 | Altan Fareed Ahmed | Radiology | 4500 San Pablo Rd S, Jacksonville, FL 32224 | 2013-04-30 |
| 1902169527 | Daniel George | Radiology | 4500 San Pablo Rd S, Jacksonville, FL 32224 | 2012-06-19 |
| 1336408020 | Saeed Bashir | Radiology | 655 W 8th St, Jacksonville, FL 32209-6511 | 2012-05-15 |
| 1659639169 | Zlatko Devcic | Radiology | 4500 San Pablo Rd S, Jacksonville, FL 32224 | 2012-05-03 |
| 1669771168 | American Access Care of Jacksonville LLC | Radiology | 2416 Dunn Ave, Jacksonville, FL 32218-4604 | 2011-03-23 |
| 1427367770 | Vascular Access Center of Jacksonville LLC | Radiology | 6820 Southpoint Pkwy, Jacksonville, FL 32216-6276 | 2010-10-05 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32257 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.