ST AUGUSTINE ORAL & FACIAL SURGICAL CENTER PA
NPI 1629288824
Oral & Maxillofacial Surgery in St Augustine, FL
NPI Status: Active since May 23, 2007
Contact Information
1301 PLANTATION ISLAND DR S
SUITE 101
ST AUGUSTINE, FL
ZIP 32080
Phone: (904) 460-0505
Fax: (904) 460-0506
- Organization
- Oral & Maxillofacial Surgery
- CLIA Number: 10D1067825
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 04-25-2027
About ST AUGUSTINE ORAL & FACIAL SURGICAL CENTER PA
This page provides the complete NPI Profile along with additional information for St Augustine Oral & Facial Surgical Center Pa, a provider established in St Augustine, Florida operating as a Oral & Maxillofacial Surgery. The healthcare provider is registered in the NPI registry with number 1629288824 assigned on May 2007. The practitioner's primary taxonomy code is 204E00000X with license number DN15568 (FL). The provider is registered as an organization and their NPI record was last updated 18 years ago. St Augustine Oral & Facial Surgical Center Pa operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Dr. Douglas L Johnson Dds (Owner)
- NPI
- 1629288824
- Provider Name
- ST AUGUSTINE ORAL & FACIAL SURGICAL CENTER PA
- Entity Type
- Organization
- Location Address
- 1301 PLANTATION ISLAND DR S SUITE 101 ST AUGUSTINE, FL 32080
- Location Phone
- (904) 460-0505
- Location Fax
- (904) 460-0506
- Mailing Address
- PO BOX 7870 SPRINGDALE, AR 72766
- Mailing Phone
- (479) 464-5824
- Mailing Fax
- (904) 460-0506
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-23-2007
- Last Update Date
- 06-23-2008
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Oral & Maxillofacial Surgery
- Taxonomy Code
- 204E00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- DN15568
- License State
- FL
- Taxonomy Description
- Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 1223S0112X | Dental Providers | Dentist | DN15568 (FL) |
| 2 | 2082S0099X | Allopathic & Osteopathic Physicians | Plastic Surgery | DN15568 (FL) |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| DD5857 | OTHER (01) | FL | RAILROAD MEDICARE GROUP |
| K5486 | MEDICARE PIN (08) | FL | |
| U85447 | MEDICARE UPIN (02) | FL |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 10D1067825
- Facility Type
- Physician Office
- Certificate Effective Date
- April 26, 2025
- Certificate Expiration Date
- April 25, 2027
- Laboratory Director
- DOUGLAS JOHNSON
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to St Augustine Oral & Facial Surgical Center Pa to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1629288824, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 76. The final step is to find the difference between that total and the next multiple of ten (80 - 76 = 4).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 76 is 80. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
ST AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
SAINT AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
SAINT AUGUSTINE, FL 32080
SAINT AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
ST AUGUSTINE, FL 32080
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1629288824, enumerated as an "organization" on May 23, 2007.
The provider is located at 1301 PLANTATION ISLAND DR S SUITE 101 ST AUGUSTINE, FL 32080 and the phone number is (904) 460-0505.
Oral & Maxillofacial Surgery with taxonomy code 204E00000X.
The provider might be accepting Accepts: Railroad Medicare, Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
