JAX HEALTH LLC (NPI# 1093331456) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093331456 |
| Entity Type | Organization |
| Organization Name | JAX HEALTH LLC |
| Practice Address |
4540 Southside Blvd Ste 401 Jacksonville FL 32216-5488 |
| Mailing Address |
Po Box 24556 Jacksonville FL 32241-4556 |
| Practice Telephone | 3213233618 |
| Mailing Telephone | 7863701111 |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2020-06-22 |
| Authorized Official Name | RAFAEL FOSS (OWNER) |
| Authorized Official Telephone | 7863701111 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities | ||
| N | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities | ||
| Y | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
4540 SOUTHSIDE BLVD STE 401 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32216-5488 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831739887 | Melanie Bautista | Nurse Practitioner | 4540 Southside Blvd Ste 401, Jacksonville, FL 32216-5488 | 2020-01-07 |
| 1801409909 | Islimlipo | Clinic/Center | 4540 Southside Blvd Ste 401, Jacksonville, FL 32216-5488 | 2020-08-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013524925 | Renee Cherie Titus | Behavior Technician | Growing Together Center 6789 Southpoint Parkway, Building 100, Jacksonville, FL 32216 | 2020-09-24 |
| 1811546575 | First Coast Orthopedic Center, LLC | Clinic/Center | 4035 Southpoint Boulevard, Jacksonville, FL 32216 | 2019-09-05 |
| 1922578558 | Fatima Hussain Crofton | Optometrist | 7051 Southpoint Parkway S 300, Jacksonville, FL 32216 | 2018-11-27 |
| 1154802833 | John-paul Pham | Internal Medicine | 4141 Southpoint Drive East, Suite D, Jacksonville, FL 32216 | 2018-08-22 |
| 1790279479 | Joseph Richard Kennedy | Physician Assistant | 6650 Corporate Center Pkwy Apt 1604, Jacksonville, FL 32216 | 2018-06-18 |
| 1801304357 | Kelli M. Tyson | Nurse Practitioner | 3550 University Blvd. S., Ste 302, Jacksonville, FL 32216 | 2018-01-18 |
| 1376054809 | Angela M Whittinghill | Counselor | 8833 Perimeter Park Blvd #702, Jacksonville, FL 32216 | 2017-10-24 |
| 1629508072 | Zoryana Yufan | Dentist | 8750 Perimeter Park Blvd Ste 101, Jacksonville, FL 32216 | 2017-06-19 |
| 1700318896 | Christina Kaczmarek | Behavior Technician | 6816 Southpoint Pkwy Ste 500, Jacksonville, FL 32216 | 2017-03-29 |
| 1932640422 | Loudine Racius | Nurse Practitioner | 8539 Gate Parkway W, Unit 1422, Jacksonville, FL 32216 | 2017-03-16 |
| Find all providers in zip 32216 | ||||
| Taxonomy Code | 2081P2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pain Medicine |
| A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962565457 | Mark Charles Hofmann | Physical Medicine & Rehabilitation | 2968 Rainbow Rd, Jacksonville, FL 32217-2435 | 2006-12-18 |
| 1578669933 | Jawed Hussain | Physical Medicine & Rehabilitation | 4063 Salisbury Rd Ste 100, Jacksonville, FL 32216-6199 | 2006-09-15 |
| 1396792818 | Allevia Medical, LLC | Physical Medicine & Rehabilitation | 14482 Cherry Lake Dr E, Jacksonville, FL 32258-5178 | 2006-05-29 |
| 1427011741 | Frank R Collier Jr. | Physical Medicine & Rehabilitation | 2627 Riverside Ave Fl 3, Jacksonville, FL 32204-4712 | 2006-04-08 |
| 1467445403 | Bao Tien Pham | Physical Medicine & Rehabilitation | 6816 Southpoint Pkwy, Suite 302, Jacksonville, FL 32216-1700 | 2005-08-24 |
| 1790045623 | Kyle R Bovee | Physical Medicine & Rehabilitation | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2012-05-25 |
| 1932428380 | Monika Yogesh Patel | Physical Medicine & Rehabilitation | 655 W 8th St, Jacksonville, FL 32209-6511 | 2010-05-25 |
| 1124273529 | Sunshine Spine and Pain, Pa | Physical Medicine & Rehabilitation | 3 Shircliff Way, Suite 610, Jacksonville, FL 32204-4757 | 2008-11-26 |
| 1215118062 | Accmed Healthcare Systems Inc | Physical Medicine & Rehabilitation | 6816 Southpoint Pkwy, Suite 302, Jacksonville, FL 32216-1700 | 2007-11-21 |
| 1801000161 | Ferdinand Joseph Formoso | Physical Medicine & Rehabilitation | 11555 Central Pkwy, Suite 304, Jacksonville, FL 32224-2691 | 2007-05-09 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32216 |
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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.