| St Vincents Family Medicine Center | |
|
2627 Riverside Ave Jacksonville FL 32204-4712 | |
| (904) 308-7372 | |
| Not Available |
| Full Name | St Vincents Family Medicine Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 2627 Riverside Ave, Jacksonville, Florida |
| Authorized Official Name and Position | Gene Miyamoto (COO) |
| Authorized Official Contact | 9043081290 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Vincents Family Medicine Center 2627 Riverside Ave Jacksonville FL 32204-4712 Ph: (904) 308-7372 | St Vincents Family Medicine Center 2627 Riverside Ave Jacksonville FL 32204-4712 Ph: (904) 308-7372 |
| NPI Number | 1427005131 |
|---|---|
| Provider Enumeration Date | 05/28/2006 |
| Last Update Date | 03/26/2010 |
| Medicare PECOS PAC ID | 0244144558 |
|---|---|
| Medicare Enrollment ID | O20031119000296 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427005131 | NPI | - | NPPES |
| 057339600 | Medicaid | FL | |
| 99612 | Other | FL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Robert F Raspa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356333603 PECOS PAC ID: 2466366786 Enrollment ID: I20031119000335 |
| Provider Name | Duaine D Murphree |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356333694 PECOS PAC ID: 3476457649 Enrollment ID: I20031120000654 |
| Provider Name | David A Mcinnes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306838743 PECOS PAC ID: 9830095389 Enrollment ID: I20031208000500 |
| Provider Name | Terrence Lee Soldo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912094574 PECOS PAC ID: 2567491061 Enrollment ID: I20050804001078 |
| Provider Name | Felix N Acholonu |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194786517 PECOS PAC ID: 3476572280 Enrollment ID: I20051121000993 |
| Provider Name | Maria Mahmoodi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306892146 PECOS PAC ID: 9830119023 Enrollment ID: I20051202000278 |
| Provider Name | Sonya J Dominguez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063468247 PECOS PAC ID: 1052310661 Enrollment ID: I20061208000412 |
| Provider Name | Donna M Vanloock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598955122 PECOS PAC ID: 3678633419 Enrollment ID: I20081124000301 |
| Provider Name | Helena Jane Karnani |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336131770 PECOS PAC ID: 0446391163 Enrollment ID: I20100104000245 |
| Provider Name | Donna Robin Potts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295727543 PECOS PAC ID: 3375684012 Enrollment ID: I20100104000361 |
| Provider Name | Daina P Greene |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1164463147 PECOS PAC ID: 9335275445 Enrollment ID: I20100329000333 |
| Provider Name | Sandra J Schellhorn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497928089 PECOS PAC ID: 4789877945 Enrollment ID: I20101020000314 |
| Provider Name | Max O Solano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962494542 PECOS PAC ID: 3577740703 Enrollment ID: I20110615000530 |
| Provider Name | Caroline Jeannette Carrion Zaragoza |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1346394681 PECOS PAC ID: 8123128485 Enrollment ID: I20121214000109 |
| Provider Name | Bashyam S Iyengar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205137403 PECOS PAC ID: 1456532779 Enrollment ID: I20130326000421 |
| Provider Name | David Lynn Miller |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1205060878 PECOS PAC ID: 0345481263 Enrollment ID: I20130718000486 |
| Provider Name | Suny Mariel Caminero |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588898258 PECOS PAC ID: 0941442271 Enrollment ID: I20130815000349 |
| Provider Name | Naicie A R Marrow |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669606232 PECOS PAC ID: 8426282302 Enrollment ID: I20131008001257 |
| Provider Name | Qudratullah Mojadidi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1700081585 PECOS PAC ID: 7416994835 Enrollment ID: I20140313000498 |
| Provider Name | Danielle M Carter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508187451 PECOS PAC ID: 0244464154 Enrollment ID: I20160301002344 |
| Provider Name | Michael Peterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184037020 PECOS PAC ID: 9537467329 Enrollment ID: I20160412000272 |
| Provider Name | Julie A Kellogg |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1447225768 PECOS PAC ID: 5294026175 Enrollment ID: I20160623001641 |
| Provider Name | Jason Wayne Largen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881007649 PECOS PAC ID: 6002195591 Enrollment ID: I20170615002672 |
| Provider Name | Fernando Moreno |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1629055280 PECOS PAC ID: 2264707488 Enrollment ID: I20171013000694 |
| Provider Name | Regina M George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477079036 PECOS PAC ID: 0345515516 Enrollment ID: I20171014000260 |
| Provider Name | Jeffrey Alan Mathison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922113752 PECOS PAC ID: 3577513449 Enrollment ID: I20180809006029 |
| Provider Name | Sara Kramer-wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275968836 PECOS PAC ID: 7517211097 Enrollment ID: I20181120001101 |
| Provider Name | Christopher Deshawn Watson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972990141 PECOS PAC ID: 2163736117 Enrollment ID: I20181128002949 |
| Provider Name | Jennifer R Snell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598250730 PECOS PAC ID: 0446687370 Enrollment ID: I20211214000206 |
| Provider Name | Lisa Michelle Alley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477170488 PECOS PAC ID: 8628494564 Enrollment ID: I20231127000112 |
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