MEDSTAR CLINIC LLC
NPI 1528809373
Internal Medicine in Jacksonville, FL

Active since June 05, 2024CLIA 10D2315511 · Waiver
6817 SOUTHPOINT PKWY STE 1602, JACKSONVILLE, FL 32216(904) 902-0091(904) 600-5299 Get Directions Write a Review

NPPES record last updated: March 10, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 10, 2026, Feb 24, 2025, Jun 5, 2024 (3 updates tracked since 2024).

About Medstar Clinic Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MEDSTAR CLINIC LLC (NPI 1528809373) is a healthcare organization registered as an internal medicine in Jacksonville, Florida and active in the NPI registry since June 2024. The organization holds a CLIA Waiver certificate valid through December 12, 2026, maintains a secondary practice location in Jacksonville, and lists Viral Acharya, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1528809373
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameMEDSTAR CLINIC LLC
Location Address6817 SOUTHPOINT PKWY STE 1602Jacksonville, FL 32216-6298
Mailing AddressPo Box 550750Jacksonville, FL 32255-0750 · (904) 902-0091 · Fax (904) 600-5299
Fax(904) 600-5299
Organization SubpartNo
Authorized OfficialViral AcharyaAuthorized Official · (904) 902-0091
Enumeration DateJune 5, 2024
Last NPPES UpdateMarch 10, 20263 updates tracked since enumeration
NPPES CertifiedMarch 10, 2026
✔ NPI 1528809373 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedFamily MedicineTaxonomy 207Q00000X
6817 SOUTHPOINT PKWY STE 1602, Jacksonville, FL 32216

Secondary Practice Location 1

Location 16817 Southpoint Pkwy Ste 1302Jacksonville, FL 32216-6297 · Phone (904) 902-0091 · Fax (904) 600-5299

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Medstar Clinic Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Medstar Clinic LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Internal Medicine
NPI 1639331176
6817 SOUTHPOINT PKWY STE 1602
Jacksonville, FL 32216
(904) 902-0091
✔ PECOS✔ Accepts MedicareSame address
Internal Medicine
NPI 1235103912
6817 SOUTHPOINT PKWY STE 1602
Jacksonville, FL 32216
(904) 902-0091
✔ PECOSSame address
Family Practice
NPI 1174719322
6817 SOUTHPOINT PKWY STE 1302
Jacksonville, FL 32216
(904) 902-0091
✔ PECOS✔ Accepts Medicare0.2 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2315511

Medstar Clinic LLC · Jacksonville, FL
Active · expires Dec 12, 2026
CLIA Number10D2315511
Laboratory TypePhysician Office
Certificate Effective DateDecember 13, 2024
Certificate Expiration DateDecember 12, 2026
Laboratory DirectorMohamed E. Shaalan
Laboratory Phone(904) 902-0091
Laboratory LocationMedstar Clinic LLC6817 Southpoint Parkway Suite 1602, Jacksonville, FL 32216
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Medstar Clinic LLC's NPI number?

The NPI number for Medstar Clinic LLC is 1528809373. It was assigned to this organization in the NPPES registry on June 5, 2024.

Where is Medstar Clinic LLC located?

Medstar Clinic LLC is located at 6817 Southpoint Pkwy Ste 1602, Jacksonville, FL 32216. The listed phone number is (904) 902-0091.

What is Medstar Clinic LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Medstar Clinic LLC enrolled in Medicare?

Yes. Medstar Clinic LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Medstar Clinic LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Medstar Clinic LLC, in Family Practice and Internal Medicine. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Medstar Clinic LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2315511) is associated with this NPI, valid through December 12, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Medstar Clinic LLC was last updated on March 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.